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TREASURY DEPARTMENT

UNITED STATES PUBLIC HEALTH SERVICE

MISCELLANEOUS PUBLICATION No, 18

MANUAL OF THE
MENTAL EXAMINATION OF
ALIENS

1918 , t :V ■

Prepared under direction of the Surgeon General

I Br t v

WASHINGTON

GOVERNMENT PRINTING OFFICE
1918 ;

TREASURY DEPARTMENT

UNITED STATES PUBLIC HEALTH SERVICE

MISCELLANEOUS PUBLICATION No. 18

MANUAL OF THE
MENTAL EXAMINATION OF
ALIENS

1918

Prepared under direction of the Surgeon General

WASHINGTON

GOVERNMENT PRINTING OFFICE
1918

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TABLE OF CONTENTS.

Page.

reduction 5

jnmarv of laws bearing on mental inspection of immigrants. . 8

! Comment on imposition of fines 10

mary inspection 12

.per environment and attitude for intensive examination. . 15

5 of interpreters .' 15

e normal immigrant 18

:ondary examination of suspected mental defectives 19

Taking of history 19

Physical examination 20

Mental examination 21

Ascertaining amount of acquired knowledge 21

Ascertaining mental activities 23

Questions to test reasoning ability 24

Counting and mathematical problems 26

Simple sums 27

Repeating digits 28

Cube test 29

Copying 29

Performance tests 30

ignosis in infancy and childhood 36

examinations 39

lanity 40

institutional psychopathic inferiority • 44

spital management of mental cases 46

/estigat.ion of public charge mental cases 46

pendix A. Immigration law 51

pendix R. Questions for use in mental examinations 61

pendix C. Vocabularies of foreign languages for use in

questioning aliens Faces 69

pendix D. Histories of cases certified as mentally defective

it Ellis Island 70

.pendix E. Histories of cases certified as insane at Ellis

island 105

pendix F. Blank forms, etc., used at Ellis Island 109

INTRODUCTION.

his Manual has been prepared under the direction of the
geon General by officers of the Public Health Service who
e had extensive experience in the examination of inimi-
its at Ellis Island, N. Y. As something like seven-tenths of
immigration to the United States enters through the port
,Sfew York, there has resulted at that place an exceptional
ortunity for the study and observation of the subject treated
n this article. The methods presented in this Manual are
result of a process of evolution in which the collaborative
rt of many officers has entered and are offered as those that
e been found most useful in the mental examination of
aigrants.

his Manual is not intended to fulfill the purpose of a text-
k, but merely to be a guide to inexperienced officers in the
lication of their knowledge of mental diseases and defects,
smuch as the problem of determining the mental status of
alien often presents peculiar difficulties. The immigrant
erally appears for examination as to his mental condition
hout the examiner being possessed of the aids that ordinarily
er into the determination of such a question. The history of
family, as well as his personal history, is unknown and
•btainable. His previous environments can be only esti-
ted or suspected. His friends and relatives, as well as him-
are unwilling to lend their cooperation and the statements
ich are made by them must all be accepted with suspicion,
, as experience has shown, they are more interested in secur-
entry of the alien than in assisting in obtaining the truth,
reover, the question of language and of race adds much to
difficulty of the situation.

Vhile it is not expected that the medical officer can become,
bin a few weeks, a competent alienist, he can, by proper
dication and within a reasonable time, fit himself to be highly

MENTAL EXAMINATION OF ALIENS.

useful and competent in the discharge of his duty pertafi
to the mental examination of immigrants. It is not esser
that the diagnosis should attain the ultimate degree of re
ment. All that is necessary is the determination of that de,
of mental alienation or enfeeblement which renders neces;
under the law certification of the immigrant. The proced
however, is by no means unattended with difficulties and
quires reasonable familiarity with the principles of psyclih
The greater such familiarity, the more efficient the exami;
officer.

Of all the serious problems in the field of public-he
activity, that of the mental examination of arriving alien
one of the most important, and the detection of the insane
the mentally defective among arriving aliens and the preven
of their entry has a value that, from the standpoint of nati
welfare, can hardly be overestimated. Physical disability
give rise to dependency, but with the death of the individual
Nation is relieved of the burden. In the case of the insan
mentally defective there is imposed a burden which tend
perpetuate itself. Each mental defective may become the
genitor of a line of paupers, vagrants, criminals, or insane
sons which will terminate only with the extinction of the 1
Were the expense to be purely financial it would be deplor
enough, but to the cost in dollars and cents must be added
ever-present moral degeneracy and its pernicious influence i
society.

Medical officers engaged in the mental examination of al
should thoroughly realize the gravity of their obligation,
this work of safeguarding the public health, particularly in
field of mental hygiene, they should be judiciously impartia
their examination and in their diagnosis, and should not
swayed by their personal sympathy to modify in any way t
professional judgment.

A brief experience in this work will soon make it eviden
any officer so engaged that he must exercise the utmost
an 1 judgment in certifying immigrants as to mental alieua
or deficiency. The necessity for withdrawal of certificat
calculated to impair the confidence of the immigration autl
ties in the medical examination and would tend to reflect

MENTAL EXAMINATION OF ALIENS.

dit upon the examiners. It is urged, therefore, that an officer
mid always fully and carefully weigh the case before sign-
a certificate, in order that he may avoid the disagreeable
:y later of possibly having to reverse himself.

Che medical examiner should ever keep in mind the purely
/isory relation which he bears to the immigration authori-
5, and in making out the certificates which furnish informa-
q to immigration boards he should endeavor to prepare them
that, as far as possible, the presentation of the case should
[clear to the average layman. In connection with this man-
medical officers engaged in the mental examination of aliens
mid thoroughly familiarize themselves with tlm Regulations
verning the Medical Inspection of Aliens, and should also
.d the various special articles prepared by officers of the
blic Health Service on the medical examination of arriving
ens and on the subject of immigration in general.

SUMMARY OF LAWS BEARING ON MENTAL INSPEto
TION OF IMMIGRANTS. *

fir

Congress has endeavored to prevent the entrance of mental®
unsound individuals into this country by passing laws, whP
to date may be summarized as follows: <1

All aliens afflicted with idiocy, insanity, imbecility, feeb tl
mindedness,1 epilepsy, constitutional psychopathic inferiori it
or chronic alcoholism, or who have previously had an attack Is,
insanity are to be excluded. It is also provided that any p t
son not coming under the above classification who is certified
be mentally defective is to be excluded. li

The physical and mental examin; tion of arriving immigraiif
must be made by medical officers of the United States Pub i
Health Service who have had at least two years’ experience 11
the practice of their profession since receiving the degree
doctor of medicine. In case of emergency, when officers of t
Public Health Service are not available, civil surgeons w.li
have had not less than four years’ professional experience m
be employed for this purpose.

The law provides that all aliens shall be examined by n
less than two medical officers, at the discretion of the Secreta
of Labor, and also that medical officers of the Public Heal
Service who have had special training in the diagnosis of i
sanity and mental defects shall be detailed for duty or ei
ployed at all ports of entry designated by the Secretary
Labor.

Provision is made for a board oi medical officers convened 1
the Surgeon General, to which an alien certified for insanity

1 Definitions of these terms will be found in sec. 63 of Regulatio
Governing the Medical Inspection of Aliens. In the enforcement of t
immigration laws “ feeble-mindedness ” is understood to mean a degr
of mental defect above that of the idiot and imbecile, and the word h
that meaning in this manual.

MENTAL EXAMINATION OF ALIENS. 9

;al defect may appeal his case and present one expert med-
witness.

'dieal officers of the Public Health Service may be detailed
luty in foreign countries in connection with the enforce-
: of the immigration law.

e master of a steamship arriving with aliens on board, or
irst or second below him in command, must make oath or
nation that he has caused the ship’s surgeon to make a
leal and mental examination of each alien, and the surgeon
quired to make oath or affirmation that he has done so
that the list or manifest is full, correct, and true in all
culars relative to the mental and physical condition of the
is.* 1

the examining surgeons certify that any alien is afflicted
idiocy, imbecility, feeble-mindedness, insanity, epilepsy,
itutional psychopathic inferiority, or chronic alcoholism
give an opinion that the condition might have been detected
competent examination at the foreign port of embarkation,
Secretary of Labor may impose a fine of $200 on the com-
bringing the alien, and in addition compel it to pay to the
a sum equal to that paid by him for his transportation from
nitial point of departure to the port of arrival. If a com-
i bring in an alien afflicted with any mental defect other
those above specifically named, a fine of $25 may be imposed,
the sum paid by the alien for his transportation must be
ided to him. These tines to not apply to railroads entering
Jnited States from foreign contiguous territory,
a vessel carrying passengers between a port of the United
;s and a foreign country has on board employed thereon
alien afflicted with idiocy, imbecility, insanity, or epilepsy
a medical officer of the Public Health Service certifies that
lien was so afflicted at the time he was engaged or taken
bard and that the existence of such affliction might have
detected by a competent medical examination at such time,
; of $50 may be imposed.

the vessel carries no surgeon, the examination must be made by
competent surgeon at the port of embarkation, and he must so

1 on the manifest.

MENTAL EXAMINATION OF ALIENS.

If an alien is rejected on account of mental disability anc
lie or she is accompanied by an alien whose care is required
the rejected alien, and the medical officers so certify, the J
companying alien may be excluded also.

A rejected alien may be held for treatment until fit to trajj

The law admits all aliens on probation. At any time witj
five years after entry they may be deported if found to have bj
in a deportable class when admitted. Any alien who within :
years after entry becomes a public charge from causes (
affirmatively shown by himself or friends to have arisen sul
quent to landing is also to be deported.

COMMENT ON IMPOSITION OF FINES.

Tf an idiot, imbecile, feeble-minded person, epileptic, chrc
alcoholic, or person suffering with constitutional psychopal
inferiority is found who could have been detected by a compel
examination at the port of embarkation, the examining offi<
should attach to the certificate a statement to this effect for '
information of the immigration authorities, in order that
proper fine may be imposed.

It is evidently the intention of the law to compel steams
companies to exercise reasonable care to avoid as far as ]
sible bringing into this country mentally unfit immigrants,
in the practical application of this section of the law we she
regard the term “ a competent medical examination ” to m
an examination of substantially the same character and sc
as that conducted at the port of arrival. It is proper, liowe
to make due allowance for the difficulties which of neees
surround the examination of immigrants at the port of
parture. It would not be feasible to detain people there fc
week or more on mere suspicion for the purpose of giving tl
mental tests, although such detention is allowable at the ]
of arrival. Cases which are easily and promptly diagne
here should be put into the class for which fines should be
posed. Idiots and imbeciles will always fall in this class,
except in the presence of obvious physical anomalies, a
is seldom justified in cases of mental deficiency above the gi
of imbecility.

MENTAL EXAMINATION OF ALIENS.

In the case of the insanities due allowance should be made for
e sudden development of manic or depressive symptoms in
irsons who might have appeared entirely normal when the
ssel sailed. The time of development as shown by the lus-
ty should determine the course of action in cases of this kind,
kewise it is to be remembered that many delusional case.^
|owT nothing in their facies and very little in their conduct
I conversation which would make them easily detected. With
few exceptions, fines for bringing in insane persons will be
stifled only in those cases showing deterioration, mannerisms,
d peculiarities of facies or abnormal conduct, and whose type
psychosis is such that it could not have arisen after embarka-
n.

With the accumulated data obtained after several weeks’ ob-
,’vation on shipboard and at the immigration station, it is
fen possible to diagnose cases of constitutional psychopathic
I'eriority and chronic alcoholism which could not have been
flier detected, and the occasions where a fine can be imposed
■ these conditions are rare. This is especially true of the
mer.

[n general, caution should be observed in applying this sec-
n of the law in its relation to the mentally abnormal imini-
int, and due allowance made for the variations in the conduct
many of these patients which make them conspicuously abnor-
1 at one time and apparently normal at another.

PRIMARY INSPECTION.

Regulations for the mental examination of aliens are giv
in sections 24-61 of Miscellaneous Publications No. 5.1 The p
ceaure to be followed at the different ports will depend in gr<
measure upon local conditions. That followed at Ellis Islai
through which seven-tenths of all immigrants pass, will
found in detail in Reprint No. 39S from the Public Health 1
ports.2 It appears desirable to consider some points not toucl
upon in these two publications in regard to the signs to
detected at the primary inspection.

The ideal method of detecting mental irregularities would
to subject each individual to careful examination and more
less prolonged observation. Unfortunately the volume of w<
which must be performed in a given time and other circi
stances usually preclude such a course, and the method u:
must be that of attempting rapidly to select from the total ni
her those individuals whom it is thought may have some mer
defect. These are then held for a more careful examinat
and, under certain circumstances, for prolonged observation.

This primary mental examination represents, of course,
first contact with the alien, and is of supreme importance. II
indeed, the critical point. Once it is passed and the immigr
allowed to go his way, he will never again be seen, unless he
apprehended and returned by municipal or State authorities.

The detection of insane persons at the primary examinat
will, of course, depend to some extent on such circumstances
the type of insanity and the stage of the disease. Evidei
certain types which do not show mental deterioration or phys

1 “ Regulations governing the Medical Inspection of Aliens,” Pt
Health Service, 1917.

* May 18, 1917.

Fig. 1— An average group of suspected mental defectives, selected from about two hundred who were chalked “X”
on the line inspection. In the back row, from the left, the first and fifth girls, and in the front row, the second,
third, and fourth were finally certified feeble-minded.

Fig. 2. — Low-grade imbecile. Age, 11 Years*

Fig. 3.— High-grade imbecile. Age, 17 years.

Fig. 4. — Low moron. Age, 30 years.

Fig. 5. — A constitutional inferior.

Fig. 6.— A chronic alcoholic (on a base
of constitutional inferiority).

Fig. 7.— Dementia precox. Facial rigidity
and clenching of teeth.

Fig. 8. — Dementia precox. Apathy.

Fig 9. — Irritability and surliness. The
firm mouth and earnestness of expres-
sion suggest combativeness.

Fig. io.— A typical expression of
anxiety.

Fig. 11. — Advanced juvenile paretic.
Expression of apprehension. I he
facial expression suggested feeble-
mindedness.

Fig. 12. — Well-marked manic state,
happy and overactive, yet the
expression does not suggest it. In
fact, mental disorder of no kind is
suggested.

Fig. 13. — An advanced paretic. Lack
of lone and expression rv.th ironing
out of one naso-labial fold.

Fig 14 — Dementia paralytica. Ex-
pression earnest, attentive, and
serious. Does not suggest mental
disorder.

MENTAL EXAMINATION OF ALIENS.

MENTAL EXAMINATION OF ALIENS. 13

hanges incident to the psychosis can not be readily detected
'ther types may escape detection, because at the particular time
f examination they may not display mental peculiarities, as
ould be quite possible, for example, in some cases of dementia
raecox and manic depressive insanities.

Idiots and imbeciles will, as a rule, hardly escape detection
/ experienced officers. Detection of higher grades of mental
?fectiveness offers, however, peculiar difficulties.

In endeavoring to pick out aliens who may have mental de-
cts, one is guided largely by their appearance, attitude, and
induct. Most experienced examiners agree that very little de
mdence can be placed upon appearance alone, although idiots
id many imbeciles generally present some physical signs which
imediately attract attention to their mental condition.

The low, narrow forehead, receding chin, closely set eyes, pro-
uding and misshapen ears, and other facial irregularities so
ten referred to as the “ signs of degeneracy ” have not the im-
rtance formerly supposed. A great many feeble-minded per-
ns on ordinary inspection present no physical signs whatever

Iiich would indicate real lack of intelligence. Nevertheless,
e examiner should have made close observation of facial ex-

i"essions, both in normal and abnormal persons, especially as to
lether they may be said to be gloomy, sad, anxious, apprehen-
re, elated, hostile, confused, sleepy, cyanotic, exalted, arrogant,
(nceited, restless, impatient, etc. An examination of the photo-
gaphs which appear herewith (Figs. 1-14), may prove interest-
i g and instructive in this connection. It will be of advantage to
/ide aments, so far as appearance goes, into twro general classes,
me are dull, apathetic, slow in their movements, and do not
y the usual attention to their surroundings. These by their
• of preoccupation and obvious lack of normal interest in what
|i going on around them may in some instances excite suspicion
b to their mental soundness. Others are overstimulated, always
i motion, and their attention is easily aroused, but not held,
lese would certainly afford no clue to their true mental status
o casual inspection. On the contrary, they would often impress
fc; as being unusually bright. Muscular incoordination is also a
f;ture noted not infrequently among aments.

MENTAL EXAMINATION OF ALIENS.

In considering the attitude and conduct of aliens, due alloy
ance must be made for racial and other characteristics, and
must never be forgotten that the subject is in an environmei
entirely different from anything he has ever experienced b
fore and that as a result his mental processes are very na
urally profoundly disturbed.

The ability to talk with the alien during line inspection
obviously of immense importance to the medical examine
Under the circumstances, the use of interpreters is usual
impracticable. As a consequence, it is highly advisable th
medical officers engaged in this work acquire at least a fe
words and phrases in the several foreign languages which th
are likely to encounter most frequently. It will be found
immense advantage to ask one or two simple questions. T
manner in which the alien replies will often immediately c
termine whether he should be passed or held for further exa
ination. Useful questions and phrases are given below a:
their equivalents in the different languages will be found
Appendix C.

Numbers 1 to 50.

tin

ntii

:ftli

?>
; inn

lent.

iitis

Days of the week and months
of the year.

What is your name?

How old are you?

Where do you come from?
Where are you going?

What is your work?

Did you ever go to school?
Can you read and write?
Name the days in the week.

Name the months in the yea
Count from 1 to 20.

Count backward from 20 to
How much is 4 and 4?
How much is 4 away from ]
What is this?

Do what I do.

Draw this.

Are you sick?

Come here.

Go ahead.

uadi

fli

leu

While this entire list will be found useful, some parts oi
are more so than others. Experience shows that the most
sential are the following:

Counting from 1 to 20. How old are you?

Where are you going? How much is ?

It is suggested, therefore, that these be first acquired and
others added gradually as need arises and experience gro

(DC;

rta!

led

lerc

MENTAL EXAMINATION OF ALIENS.

JOPER ENVIRONMENT AND ATTITUDE FOR INTEN-
SIVE EXAMINATION.

in conducting any examination which is to be regarded as
(elusive it is highly essential that all conditions be favorable
i he subject. The room should be quiet and well ventilated,
Y. as much of the official surroundings should be removed
s circumstances will permit. The temperature of the room
i winter) should not be over 70° F. A bath, a good meal,
p, and examination in the morning will give the immigrant
opportunity to be at his best. Not more than three persons
jild be present at the examination: The alien should thor-
lly understand the interpreter, and the latter should be
patient, and sympathetic. The alien should never be told
he is wrong when he makes a mistake nor discouraged in
way. The examiner should impress the alien with his good
ntions and give an easy test to start with,
the subject is a child, the parents may be either a great help
great hindrance, depending on their attitude. If a timid
inn is to be tested and there are other more fearless women
ent, one of the latter should be taken first. If the immi-
t is stubborn or emotional, suitable advice should be given
the case allowed to wait over a day or so. When the
ude is found to be a chronic one, however, the examination
Id be deferred no longer. Prolonged detention is unde-
>le and impractical. Nevertheless, the decision is one
ght with such consequences to the alien that it should not
lade hastily. He should be reexamined until the officer
that he can conscientiously go into court, if necessary,
defend his action.

USE OF INTERPRETERS.

e necessity of employing an interpreter detracts from the
rts o mey of a mental examination. In cases of suspected
most al deficiency the interpreter may sometimes be eliminated
rtain intelligence tests are used and the examiner has a
(ledge of a few words and phrases in the language en-
;ered. The use of intelligence tests in dealing with those
ilael
ce gii

MENTAL EXAMINATION OF ALIENS.

suspected of insanity, however, is without value. A flue
knowledge of the alien’s language is necessary. It would
ideal for the examiners themselves to be well versed in t
languages and customs of the suspected aliens, for otlierwi
they will miss some cases which should be obvious. Since tl
is impossible when so many races must be dealt with an int
prefer is necessary.

Even with a careful, well-trained interpreter much is lost
any examination of an insane person. Certain significant
pressions and tones of voice can not be translated, and majp]
things which would be of great significance to a psychiati
mean nothing to an interpreter, and therefore remain untra
lated. This is a serious handicap in those cases in which
lusions are not freely expressed and which show no physi
signs or eccentricities of behavior or conduct and little, if a >|f
deterioration. In most of these examinations there is usm
no readily available history of previous antisocial conduct u
which conclusions might be based. There is no guide, but
indefinite, accidentally discovered clue.

When to the above-mentioned sources of error, confusion
uncertainty there is added an indifferent or incompetent ir
preter the difficulties of the situation are greatly increa
The advantage, then, of having the aid of a good interpret*
plainly apparent. He should be intelligent and conscient
and should have received training in the examination of me
cases.

Of prime importance is that he have a thorough knowleds
the alien’s language. Some interpreters attempt to spet,
number of languages and dialects. They may be successfi
far as ordinary interpretation is concerned; but, as before
tioned, in a mental examination it is important that every '
and expression be understood. Sometimes it is evident
the interpreter and alien do not understand each other
when the interpreter assures the examiner that they do.
a condition will be apparent, for instance, when the subjec
to be asked the same question several times before he coi
liends, and when the interpreter is uncertain about the re
This confusion often occurs and seems to be in a measur
avoidable. It is one of the reasons why tests which in

| KM

e ite<

is i
«(

»w

MENTAL EXAMINATION OF ALIENS.

mprehension of language give such poor results in the mental
animation of immigrants. Obviously in dealing with an
sane case the uncertainty is still greater and care must be
len not to draw too hasty conclusions. When a difference in
llect occurs, incoherent or irrelevant remarks can not be
:ected and even the significance of delusions may be entirely
t and the insanity remain undiscovered. On the other hand,
bright, intelligent alien may, because of faulty interpreta-
n, appear stupid or demented.

“ -he importance of exercising patience with mildness of
nner and speech should be impressed upon the interpreter,
ens are unavoidably embarrassed by the strangeness of the
11 lation in which they find themselves, and, if to this handicap
added the emotions arising from rough and unkind treatment
he hands of a uniformed officer, a true picture of their men-
3 condition will not be obtained. Some interpreters are tem-
11 imentally unfit to aid in a mental examination because they
their temper and raise their voice when receiving wrong
vers. It would be well for the above reason alone if medical
ers had their choice of interpreters.* 1

sact translation should be insisted on so far as possible,
dally in insane cases. The interpreter should understand
not he but the physician is examining the case, and that
important for the examiner to know everything which the
i says if a correct diagnosis is to be made. Time is wasted,
•xample, when the interpreter engages the subject in several
ites’ conversation, and then instead of stating what was
^ illy said gives his analysis of the alien’s remarks by in-
T ing the examiner that the alien says “ yes ” or “ no,” or does
hink he is being persecuted. Such an interpreter has made
s mind that the subject is normal and his services, so far
e cake in question is concerned, may as well be dispensed
With translations like this, clues to delusions will be lost.

:rca

;et(

are

eryi

ibjecbe temperamentally unfit could then be eliminated and those

i who take an interest in the work, pay attention to the cases, and
exact translations of what the alien says. Good results' are
“ere|i' expected so long as the mental work is only a side issue super-
easuri to their regular duties.

di ill '3889°— IS 2

MENTAL EXAMINATION OF ALIENS.

and incoherent or irrelevant conversation, which may be jv
as important as delusions, can not be detected.

It is not to be inferred, however, that an interpreter’s analy;
of a case is necessarily valueless. On the contrary, the opini
of one who has had experience in mental examinations a
who is thoroughly familiar with the language and customs
the alien's race is in many cases helpful. When, as sometic
happens, such an interpreter volunteers the information tl
something is wrong with the patient’s mind, it should be
sumed that he has good reasons for making the statenu
although nothing of especial importance has yet appeared
the examiner.1 2 3

THE NORMAL IMMIGRANT.

In order to diagnose mental disease and mental deficiency
an immigrant at an immigration station, a knowledge of the n
tal ability and conduct of the normal or average immigran
the time of landing is necessary. Such knowledge can be ga
only by experience. In order to assist a medical officer in s
a study an experimental examination of normal aliens was
dertaken at Ellis Island and is reported in Public Health
letin No. 90 — The Mentality of Arriving Immigrants. It
pears that little discussion of the normal immigrant beyond i
is contained in that report is necessary.3

It will be noticed, however, that this study was made cl
on illiterates and near illiterates from eastern and northeaf
European countries, from which most of the United States i
gration has come in recent years. The standard of norm
would be higher for people coming from northwestern Eu

rfe

i)N

1 The need of careful and explicit instructions to interpreter;
have not by experience become familiar with the purpose of
intelligence tests may be illustrated by the following incident
interpreter was requested to tell the story of the woman found
room cut into 18 pieces, and ask the alien if he thought she
herself. Missing the purpose of the story entirely, he told the
that one piece of the woman was found in one part of the town,
another part, and so on.

2 In that bulletin will also be found a description and eonsidi

of the value of many tests the use of which is advised in this man-

MENTAL EXAMINATION OF ALIENS.

pre economic conditions are better and universal education
he rule. The latter may be classed on a plane with Ameri
js, and their ability to perform intelligence tests may be
roximately estimated from the works of Binet, Goddard, and
firs, as well as from the reports of Public Health Service
ers on American school children.

li examining immigrants, these variations in mental ability
different races should be borne in mind. High-grade de-
lves who have had certain environmental and educational
ntages are able to do with ease some intelligence tests
[ih are entirely beyond the powers of many normal illiter-
laliens. It follows, therefore, that if all are judged by the
prate standard many defectives will pass; conversely, if
rates are graded according to the standards used in the case
ucated people, many normal persons would be certified as
ctives. Formal tests of ability are therefore poor substi-
for common sense and experience in the mental exami-
>n of aliens.1 Too many scales would have to be devised,
their accuracy would always be open to question. The
Station of an alien is too serious a matter to depend upon
lumber of years in intelligence he happens to fall below
bitrary age standard.

ld*)NDARY EXAMINATIONS OF SUSPECTED MENTAL
DEFECTIVES.

arriving at a diagnosis of those suspected of mental defi-
es^ on primary inspection, the history should be taken and
|tensive physical examination made and the facts obtained
i bj.o supplement the mental examination.

TAKING OF HISTORY.

aking the history it is important to remember that parents
tives are loath to admit degeneracy in the family. They
ely to conceal inferiorities and exaggerate the mental

such systems of examination the various tests used are given
in weight. The subject is scored on each test, and a general
|? made of the results. This is then compared with some more or
bitrary standard to determine whether or not the person is
e.

MENTAL EXAMINATION OF ALIENS.

powers of their offspring. In addition, immigrants knowing t
purpose of the examination have an added motive for conce:
ing the truth. Some of them are too ignorant to give sat
factory histories, even when they try to. However, questional
histories often furnish information of much assistance in 1
correct diagnosis of what might otherwise be considered
doubtful case. It is found, for instance, that labor was und'
prolonged, difficult, or instrumental, and that the infant urn
examination was therefore asphyxiated ; there may have b
convulsions in early childhood ; dentition, standing, ivalki
and speaking may have been abnormally delayed; the ch
having developed normally up to a certain age, may have
come retarded after a serious illness ; other members of
family may be insane, epileptic, or defective ; the subject i
have shown marked perversity of conduct or been unable
keep up with other children at school ; or it may be that, bee;
of his inability to learn as well as the others, he was taken
of school, and is therefore the only illiterate member of
family.

It is not often that any information of value can be obta
about an adult immigrant suspected of being defective, for
reason that the history of his early life must usually be ti
from the patient himself, and he naturally knows little, if
thing, of many important points concerning it.

per

PHYSICAL EXAMINATION.

The physical examination includes a survey of the so-c
stigmata of degeneracy. Among idiots and imbeciles theS'
common, but they are often absent in the high-grade defec
and are perhaps not much more common with them than
people who have normal minds. It is of some significance,
ever, when a person of apparently dull mentality shows t
more of these anomalies, and, in the final summing up
case, they may point the way to a correct diagnosis.

Among these so-called signs of degeneration are peculii
in the conformation of the skull, features, limbs, or

ipt

ter

ion

Sometimes the skull presents an abnormally flattened occip

malformation of the frontal or occipital region, or then

MENTAL EXAMINATION OF ALIENS.

marked asymmetry in shape. The limbs, too, may be dis-
iportionately short or disproportionately long. The normal
ation of length of the digits* to each other may be lost and
re may be polydactylism or syndactylism. The character-
cs of one sex may approach those of the other. The faces
y present unduly prominent cheek bones with a markedly
racted, small chin ; the palate may be V shaped or high
lted; the teeth deficient or excessive in number and irregu-
y shaped or implanted. The ears sometimes show undue
[minence or flattening, irregularity in size, adherent lobule,
other anomalies ; one or both eyelids droop, or there may
picanthus and small, obliquely placed palpebral fissures, so
the inner end is lower than the outer.

rtain of the anomalies mentioned above are constant char-
ristics of some races, such as the flat occiput of the Illyrians,
secondary amentia these inherited anomalies would bear
elation to the mental defect, but there are likely to be
lent physical changes, depending on causative agents such
jereditary syphilis, cretanism, hydrocephalus, and lesions of
main, causing various paralyses and contractures.1

MENTAL EXAMINATION.'

ere are two general methods used for the mental examina-
nt aliens suspected of mental defect: (1) Ascertaining the
nt of acquired knowledge which their minds contain; (2)
jipting actually to test their various mental activities.
pertaining amount of acquired knowledge. — In the first
pd the assumption is that a normal person in a given
pnment will subconsciously acquire and retain a certain
|nt of knowledge concerning the ordinary affairs of every-

je various physical accompaniments of this form of amentia are
jious that they would not escape attention in persons old enough
Ik, but infants carried in arms may show gross anatomic changes
ill pass undetected unless special attention is paid to them. This
mportant point to remember during line inspection,
a preliminary step to the study of methods of diagnosing mental
Iveness among aliens by mental tests, a careful survey of Public
| Bulletin No. 90, “ Mentality of the Arriving Immigrant,” should
e

MENTAL EXAMINATION OF ALIENS.

day life. Thus, a farmer’s boy ought to know the seasons :
sowing and reaping of crops, the amount of yield from an ac
the quantity of milk a cow gives, how long it takes a cliieke
egg to hatch, and the process of butter making, regardless
whether or not he has been to school. On the contrary,
would be unreasonable to expect a city-bred seamstress to
familiar with any of these things. She ought, however, to kn
the price of cloth, the quantity needed to make a dress,
names of colors and materials, and be able to figure the amo1
of her weekly wages. There would be other matters with wl)
both would be conversant, such as the number of hours ii
day, the months of the year, and the days of the week. T1
are many facts which may properly be considered as items
common knowledge in all civilized communities, even among
most ignorant of the population. Among these are the n; '
of the ruler, the seat of the government, and the date
significance of great religious festivals like Christmas
Easter. It is also to be expected that all persons who
employed in any occupation should be able to solve the sii
problems in arithmetic which arise in making purchases ‘
giving change. Likewise, they should know the value of
different coins and bills used in the community.

Through such questions a man’s mental capacity is gauge!

what he has absorbed and retained. It is a perfectly rel
and accurate method in cases in which the previous env
ment is known ; but it is open to the great objection th;
many instances we can not even approximately estimate
the environment has been. This is especially true in the
of foreigners. What are likely to be considered matte
universal knowledge may be absolutely unknown to the
account of the extreme limitations of their surroundings. ’
it is surprising to find that a peasant girl can not tell the
by a watch until it is learned that the only article of the

1 itr

she has ever come in contact with was the clock in the
school which she had attended for only a few weeks,
almost impossible for Americans to realize the narrown
the lives of some of the poorer classes of the countr
Europe. Many of these people live a life of sordidnes

MENTAL EXAMINATION OF ALIENS.

ird-working monotony almost beyond belief, resulting in a
ental equipment which is correspondingly limited and stunted.
>me of them can not even repeat the names of the days of the
?ek, knowing when Sunday comes only through the ringing of
e church bell. Frequently immigrants from remote districts
not know what year it is. The farmer of southern Italy, till-
;>• a few acres of land and living in a hut, the bare walls of
[deli contain only one ornament, an unframed picture of the
lidonna, and the only articles of furniture of which are a bed,
( able, a chair or two, a few kitchen utensils, and a little bed-
lg, can hardly be expected to define the word “ charity.” He
s never been 50 miles from his place of birth. He could not go

0 a room in any ordinary American home and give the name
his own language for even a small part of the things he would

there, because he has never seen or heard of them before.
3 possessions, his ideas, his vocabulary, and his experiences
all extremely limited, and he must be judged and measured
ordingly.

Thus in determining feeble-mmdedness in foreign races by
rsuring the amount of an alien’s acquired knowledge, a great

1 of time and energy must be expended in deciding what are
mal standards for each race and also for the various social
. geographical classes in each country. At best such stand-
s are only relative.

scertaining mental activities. — Testing the mental abilitv of
individual independently of the amount of knowledge he
r have acquired presents difficulties. The tests devised for

suring the higher faculties of the mind in the examination
n are largely academic and furnish rather unsatisfactory
fence as to the way the subject will use his judgment or
on in solving the problems of everyday life. Everyone knows
unsatisfactory school examinations are as a test of mental
1 ity, and the same thing is true of mental examinations.
i:ed, the division of the normal mind into its different parts
not as yet been perfectly described or defined, and many
he well-recognized divisions overlap and intermingle to a
ee so confusing that it can not always be decided exactly
t powers are involved in performing certain acts.

MENTAL EXAMINATION OF ALIENS.

Questions to test reasoning ability. — To determine the ability
of the subject to reason abstractly, to form correct judgments
and to draw logical conclusions, a considerable number o
methods may be used. As all of these overlap, they will b
taken up together. It is intended merely to mention certai
lines along with the examination may be conducted. Each ii
vestigator will modify them to suit his own individual ideas an
the case before him.

The examiner may describe an imaginary situation, callir
for a decision on the part of the subject under certain suppose
conditions. Two examples will suffice.

(1) The subject is told that he is shipwrecked aud alone in ji
small boat many hundred miles from shore. He has with hi
in the boat two boxes, one containing 50 pounds of bread ; t
other. 50 pounds of gold. The sea is very rough, and it is nece
sary to throw one of the boxes overboard to keep the boat fre
sinking. The subject is then asked to tell which box he woujia
discard.

(2) He is told that his house is on fire and burning fierce h
There is time to make but one trip to the second story. Wh
he gets upstairs he finds but two articles worth saving. Oneillii
a mattress, the other .a large lamp. He must throw one out p
the window and carry the other down. Which one will he cai
down ?

Moreover, certain premises may be stated and a false c«en
elusion drawn, the subject being asked if he concurs. For fo
ample, he is told that a young woman’s body was found ii
room, cut into 18 pieces. The police say that she commitjjto
suicide. Does he think that this is likely?

In all hypothetic questions it must be remembered that
imagination of certain classes of aliens is extremely limi
and they may make the wrong reply because they are unabh
picture the actual situation ; whereas if the thing actu
happened to them they would, in reality, take the proper cou
This lack of the constructive imagination is very significan
feeble-mindedness, but its existence is rather difficult to pr
A test along this line may be attempted by carefully drawing
imaginary picture in which something not actually mentic
is perfectly obvious to anyone who really can form the me

MENTAL EXAMINATION OF ALIENS.

ture, then by direct means ascertaining if the subject realizes
condition which has been purposely left out of the verbal
cription.

’’or example, the alien is told that he and a companion are
pwrecked in a small boat and floating on the sea. When
y left the vessel, which was destroyed, they took with them
buckets of fresh water. Several days have elapsed since
accident and they have consumed all of the water in one
ket and it is empty. The other bucket is still full of the
:h water, their only supply. He suddenly discovers that his
panion’s coat is on fire. Will he pour the bucket of fresh
er over him, or what will he do? Obviously if he can picture
situation at all he will state that he will reach over the side
fill the empty bucket with salt water and use that, or he
take the coat off and dip it in the sea.

nother good question is to ask whether in scrubbing a flight
tairs the subject would begin at the top or at the bottom.
i all questions like the above, in which two alternatives are
•ed, the reason of the choice must be given, because by
>ly guessing the right answer would be given at least half of
time.

;sts somewhat similar to these and some problems and
:a rdities are found in the introduction to the case histories
lendix D). These tests, as well as the questions of com-
i ension used in the Binet system, require some explanation
it o their application to immigrants. Their value depends
j I the educational opportunities the subject may have had and
ui anguage he speaks. In giving such tests through an inter-
ir one can not be sure that the alien has been correctly told
at : was intended, and in translating his answer some im-
mi mt detail may be unintentionally perverted or lost. Again,
§ lal immigrants with little or no schooling often fail entirely
fti miprehend the questions or see the absurdities. For ex-
tol e, with the suicide story given on page 24, it is not unusual
■t such answers as, “ Indeed, I was not there,” “ It was a
: sin for her to kill herself.” Failures as bad as these by
jji >ns who have had five or six years’ schooling point strongly
>ntj ental defect, but for most of the immigrants they have
(j significance. In general, it may be said that while these

MENTAL EXAMINATION OF ALIENS.

tests have a certain limited value in the examination of arrit
aliens, too much importance should not be attached to tl
This is especially true of the absurdities and questions of (
prehension before mentioned.

Good definitions for abstract terms such as “ justice ”

“ charity ” are not to be expected from illiterates, likewise
do not as a rule define concrete objects in terms other than

Counting and mathematical problems 2 — Examination of
ity to count and figure even to a limited degree is extremely
portant and should be made in every case. Tbe alien shoul
asked to count from 1 to 20 and then backward from 20 to 1

Inability to count from 1 to 20 by anyone above 12 yeai
age is evidence of low intelligence in nearly all cases. Very
of the most illiterate feeble-minded fail to do this on the
day examined. Normal Europeans of 15 years or more
not been known to fail, but below this age there have been a
failures in children about whose normal mentality there set
to be little doubt. Therefore, failure even by an adult car
‘be considered an absolute indication of mental deficiency
though it usually means imbecility.

One can count backward by four different mental process

1. By successively subtracting one number from the prece

2. By reverse association of the numbers in their re;
order.

3. By drawing a mental picture of the numbers in their
lar order as they would appear on a printed page and
reading them from right to left.

4. By learning them backward and repeating them by ro

Counting backward by any of the first three methods

somewhat complicated mental act and shows considerabl
gree of mental development. Counting backward by rote
not. It can easily be detected, however, by extending the
ess, as the subject fails when taken beyond the point h
learned.

Nearly all illiterates succeed with this test on the day i
rival. It is, therefore, plain that failure to learn it after

fes

'Sri

itll

Ilf

ill

1 A description of these tests and of those given on the following
will be found in Public Health Bulletin No. 90.

MENTAL EXAMINATION OF ALIENS.

five clays’ trial places the subject at least among the dullards,
is not unusual for immigrants to fail, even though their
'ends and relatives try to teach them from day to day. Some
the stupid ones take several days before they get the idea
going back at all; they go back a few numbers and then
rt forward again. It would seem that all such people must
defective, and it is probable that most of them are ; but the
;stion is not so easily determined, and it would be unwise
to certify an alien because of this failure alone.

Success, of course, does not prove that the subject has a nor-
1 mind. Many defectives who have had schooling are able
'do the test with ease, and all the feeble-minded illiterates
well as a few of the imbeciles will learn 20 to 1 by rote if
en sufficient time.

Sven though an illiterate makes a number of mistakes in
actual counting, it is considered a good performance if he
s the general idea and shows that he is working at the prob-
|i in a rational way. This is especially true on the first
mination.

f a person who has had educational opportunities makes a
ure of this test his case is regarded with extreme suspicion.
''imple sums. — As a rule failure to count backward means
■> a poor showing in simple addition and subtraction.

’ests of this kind are more valuable with illiterates than with

I rates. With the latter variations in arithmetical ability are
great, depending upon the degree of education and previous
lerience, that anything approaching a standard could not be
[iblished. Moreover, experience with one type of alien can
I, without modification, be applied to another.

Ilearly all normal illiterate immigrants solve simple abstract

Iblems such as 6+7, 8+9, 12+12, 10 — 3, and many of them
able to solve more difficult ones. They improve from day to
in their ability to do these problems, whereas mental defec-
ts show little, if any, improvement.1

Bometimes, after several months, a case will fail on such
Iple sums as 4+5 and 4+3. It would seem that anyone who

fWhile the friends of aliens certified as mentally defective are able
b each them to count backward, they have little success in improv-
d their ability to do mathematical problems.

MENTAL EXAMINATION OF ALIENS.

failed as badly as this, if only on the first day examined, wot
certainly be defective; but the diagnosis is not always cle
nor easily made. The point to determine in case of failure wi
this test is what weight should be given to it, which can oi
be determined in connection with results obtained in otl
tests.

Repeating digits. — The superficial memory and the attenti
may be readily tested by measuring the ability to repeat digi
The method used 1 has been found of more value for work w:
immigrants than the slow, monotonous repetition used by ma
other workers. Briefly, in each case the method which enab
the subject to repeat the most digits is used.

Repeating digits is one of the best tests and should be gi\
to every alien who comes to secondary examination. Capac
to perform this test naturally varies greatly with differ*
social classes and somewhat with different races. The aven
normal illiterate alien, above the age of 9, usually repeats
least 5 figures on the first day examined. After having bt
given the test on several successive days nearly all of th
do as well and many do better. Binet and Goddard give 7 as i
requirement for French and Americans, but it has been foil
that many educated, adult Americans repeat 10 or mo
Some of this latter class tested by officers at Ellis Island i
able to repeat 11, 12, and 13. It is probable that this capac
is by no means uncommon among persons whose occupat
would tend to develop this faculty. However, the majority
American school children do not retain more than 7, althoi
some as young as 6 years repeat this many or more.2 1
capacity of all Anglo-Saxons runs parallel with that of Am
icans and 7 should be considered low for adults from Engli
speaking countries. Some Irish peasant girls who have lil
education do 7, 8, and 9 with ease.

Some illiterate adults from southern Europe repeat only f*
digits and fail to improve with later examinations. Probably

1 Method described in Public Health Bulletin No. 90.

2 See “ Mental Status of Rural School Children. Report of
liminary survey made in New Castle* County, Del., with a deseriptioi
the tests employed.” By E. H. Mullan. Reprint No. 377 from Pu
Health Reports.

MENTAL EXAMINATION OF ALIENS.

these, and surely all of the men, have intelligences below
rrnal, yet many of them are not defective. It is believed,
wever, that those who fail to repeat four digits are in all
;es either defective or demented. Likewise any Anglo-Saxon
ove 12 years of age, who has had any educational oppor-
lities at all and retains only six digits, is regarded with
spicion. All of this class who repeat no more than five are
[•haps defective, but not to be certified without other evidence
subnormal mentality.

In the hands of an examiner who knows what to expect from
there is probably no single test which gives more informa-
n about the capacity of the subject’s mind. Poor ability in
; performance of this test probably means poor mentality
a larger proportion of cases than it does in other tests.

Cube test. — The cube test is also very useful. Like repeating
fits, it has been found to be a good test for all classes of
migrants and should be given to every case examined. A
ge number of combinations may be made, testing the powers
attention and memory to a greater or less degree. Obviously,
ise are the two processes chiefly involved in this test. All
iters on the subject are agreed that inability to control the
ention is a marked symptom of most defectives. With
: terates, performance with this test usually runs parallel
11 ;h their ability to repeat digits, while, on the other hand,
11 ividuals who have had schooling may make a comparatively

■ ir showing in its performance. No feeble-minded person has
1 n observed to do well with five cubes, although some of them

er practice on successive days may make a perfect score with
r. Sometimes even after several days’ trial an alien will

■ l to make one successful movement out of six with the four-
1 >e test. Such cases are always extremely suspicious and

st of them are defective. All normal persons, except quite
mg children, succeed with three cubes. Some imbeciles also
1 !ch three blocks fairly well, but their score is not likely to be
feet.

fj 'opying. — The copying of simple geometric figures, such as
'•« square, triangle, and diamond has not proved to be a good
K : for illiterate aliens. It should be kept in mind, however, as
s used quite frequently in examining those who can write.

MENTAL EXAMINATION OF ALIENS.

Performance tests. — Each immigrant should be given one
two performance tests. These consist of a frame with ernp
spaces into which blocks of corresponding size and shape f
The subject is required properly to adjust the blocks into t:
frame. There are a number of these tests, some of them ve:
simple and others more difficult. The manner in which tl
subject attempts to solve them throws considerable light on 1
general intelligence.

Such puzzles may be solved by using a very pure and hi}
form of reasoning, but it is doubtful whether they are ore
narily attacked in this manner. It requires less mental effo
actually to fit the blocks into the different spaces of the frar
in a haphazard fashion than to think out a plan of solutic
and often the correct arrangement appears to be discover
by repeated trials rather than by reason. A very low grade
reasoning is required to complete the frame in this way, the sr
ject simply remembering the previous unsuccessful combir
tions. After it has been once' worked out in this fashion
is not difficult to repeat.

With these tests errors arising through the use of int
prefers are avoided, as we are able to observe the actual wo
ings of the subject’s mind without the intervention of a thi
party. Another advantage of their use among immigrants
that, unlike many other intelligence tests, their solution do
not depend upon such acquired accomplishments as reading a
writing. Unfortunately for our work, their performance do
not depend upon native ability alone, and there is a differei
between the facility with which literate and illiterate peo;
solve them. Because of illiteracy many immigrants have be
deprived of opportunities for developing constructive abil:
It has been noticed that some children who can scarcely rel
but have had an abundance of toys and picture books do betj
with such puzzles than many adult illiterate aliens. The
terpretation of results with these tests is therefore not alw;|
easy, and they have not been found so widely useful as it v
at one time hoped they might be. Only in the case of idi|
and imbeciles would it be possible to make a diagnosis v
performance tests alone. Many normal people make a pi
showing with them, and on the contrary some defectives han

Fig. 17. — Hoaly frame.

Fig. 18. — Diamond frame test No.

Fig. 19. — Healy-Fernald construction test B.

Fig. 20. —Casuist .test.

Fig. 21.— Cross and circle frame, and diamond frame No. 2

Fig. 22. — Steamship picture form board.

MENTAL EXAMINATION OF ALIENS.

i with ease. They must then be interpreted along with
r data, including physical and environmental conditions,
n used in this way by one thoroughly familiar with their
;ations and possibilities, they form a valuable addition to
neans of detecting mental deficiency among immigrants,
it infrequently an alien who has not answered questions
itably because of apprehension arising from the new and
lge situation in w’hich he finds himself will take an interest
lese tests and become oblivious to his surroundings, thus
■ding an opportunity to acquire an insight into his mental
esses which otherwise would not be readily obtained. This
;pecially true of children of seven years or below, some of
n remain silent and afraid and refuse to cooperate in any
until given one of these puzzles.

me of the psychological problems involved in the solution
erformance tests give an insight into the subject’s atten-
memory, foresight, and planfulness, learning powers, ability
rofit by experience, apperceptive ability, and power to with-
d distraction.

presenting these tests it is essential that the subject should
u’stand just what is desired of him. To make this plain
form is shown for about 10 seconds and then turned over
the pieces allowed to fall at random. This, of course, makes
test easier to perform, as is intended. Many become dis-
aged and skeptical as to the possibility of the blocks fitting
the frame if this preliminary view is not given. To those
might be expected to do well with such tests, because of
vn environmental or educational advantages, the pieces are
n unassembled.

re Sequin form board1 was originally used for the education
nbeciles. Form perception enters into no performance tests
3 prominently than into this.

is said that with adults the time reaction is the Important
It to consider in the use of this test, and that they should
plete it in from 15 to 20 seconds. As a general rule, how-
, it has been found that time is an unsafe guide in inter-
ing performance tests with aliens. Anyone above the grade

’bese tests will be made clear by reference to the illustrations,
is. 15-22.)

MENTAL EXAMINATION OF ALIENS. 31

i with ease. They must then be interpreted along with
r data, including physical and environmental conditions,
n used in this way by one thoroughly familiar with their
ations and possibilities, they form a valuable addition to
neans of detecting mental deficiency among immigrants,
it infrequently an alien who has not answered questions
itably because of apprehension arising from the new and
ige situation in which he finds himself will take an interest
lese tests and become oblivious to his surroundings, thus
•ding an opportunity to acquire an insight into his mental
esses which otherwise would not be readily obtained. This
pecially true of children of seven years or below, some of
n remain silent and afraid and refuse to cooperate in any
until given one of these puzzles.

me of the psychological problems involved in the solution
erformance tests give an insight into the subject’s atten-
memory, foresight, and planfulness, learning powers, ability
;-ofit by experience, apperceptive ability, and power to with-
d distraction.

presenting these tests it is essential that the subject should
u-stand just what is desired of him. To make this plain
form is shown for about 10 seconds and then turned over
the pieces allowed to fall at random. This, of course, makes
test easier to perform, as is intended. "Many become dis-
aged and skeptical as to the possibility of the blocks fitting
the frame if this preliminary view is not given. To those
might be expected to do well with such tests, because of
vn environmental or educational advantages, the pieces are
a unassembled.

le Sequin form board 1 was originally used for the education
abeciles. Form perception enters into no performance tests
3 prominently than into this.

is said that with adults the time reaction is the Important
t to consider in the use of this test, and that they should
olete it in from 15 to 20 seconds. As a general rule, how-
, it has been found that time is an unsafe guide in inter-
ing performance tests with aliens. Anyone above the grade

'hese tests will be made clear by reference to the illustrations,
s. 15-22.)

MENTAL EXAMINATION OF ALIENS.

of imbecility does the Seguin board test quickly. It is so
pie that it has not been found useful except in dealing
children under six years of age or in measuring the degrt
defect in very low grade cases. Children of 5, and, indeed, r
of 4, put the blocks in place readily.

The immigrant form board or imbecile test is somewhat i
difficult than the Seguin. Unlike the latter, some of the ei1
spaces connect with each other and some of the blocks w
almost fit into other than their proper spaces.1 Normal ii
grants take from 30 seconds to 2 minutes to complete the tei
the first trial. More time does not necessarily mean defect
one who persistently makes impossible moves and takes as n
as five minutes is at least a doubtful case. In fact, some of
illiterate feeble-minded do it well on the first trial. A perso
9 years or more who, in spite of being shown the proper solr
several times on different days, still makes many foolish m
and takes as long as five minutes in its performance is ii
probability an imbecile.

This test has been found very useful because a poor perfi
ance with it on the first trial usually is suggestive of me
defect. It is not unusual for immigrants to take 10 oi
minutes with more difficult tests, and where there are man
examine the gain in time due to using this test is important.

The Healy frame is claimed by Healy to be one of his i
important tests. He says concerning it : “ No normal pe
over 8 or 9 years should fail to do it in 5 minutes. Ai
years we find great variations in the time, showing very dist
differences of ability ; some grasp and plan the task very reai
performing it in 12 minutes to 15 minutes ; nearly all of t)
normal mentally get it done in 2 hours. To be considerec
done well it should be done within these limits and witl
replacing pieces in obviously impossible positions. A plar
method is better than trial and error.”

This statement is no doubt true for the subjects with wl
Healy worked, and nothing could better illustrate the imp(
bility of standardizing any one test for work with a he
ogeneous people than a comparison of the results obtained

the f
im
Iv ai

ns s

lie
t. T

ley

131

by ac

mi
f Hi
seco
Free
I for

llrst

list

1 The most frequent source of error is with the small pieces horde
on the central circular block.

leB

list

MENTAL EXAMINATION OF ALIENS.

use of this test among immigrants with those obtained by

■ Many aliens succeed with it well within the time limits
las set ; many others take much longer, in spite of the fact

the frame is shown with the blocks in place before the test
iven. It is not unusual for an illiterate woman, less fre-
itl.\ an illiterate man, to work 10 minutes or more without
ring the slightest evidence of a plan or of ability to profit by
is. Such a result, it is believed, proves stupidity, but it
d be erroneous to consider this always evidence of mental
:t. The second trial is more important than the first with
class of subjects mentioned above. Most of them do the
quickly after one success. A poor performance after the
cr method is shown them does not often occur in normals,
.they remember it better on the next day than defectives
Some feeble-minded immigrants who have had opportunity
i'velop constructive ability do this test well, and in inter-
ng results obtained from its use as well as from other
similar in principle, account must be taken of the various
■nces which may have affected this ability.

? diamond frame No. 1 is much the same as the Healy test
t that in its accomplishment more attention must be paid
■m and adjustment. In other words, it is not likely to be
by accident.

' Healy-Fernald construction test B is for most immigrants
harder than the Healy frame. This test is used a great
n examining aliens, with the same reservations as in the
>f Healy test. Method is more important than the time
second trial for certain classes more important than the
Frequently after one trial the board is immediately re-
fer another trial, and if an alien who made a poor show-
fust quickly notes this deception and does the test well it

■ that lack of basic mentality was not the cause of the first

If an illiterate makes a good showing with this test
t is first given to him he is probably normal.
jt0 difflculty, the Casuist test may be classed with the
In its use absurd placements have the same significance
he Healy-Fernald. It may supplant the latter if reexami-
is requested.

189° — 18-

MENTAL EXAMINATION OF ALIENS.

The cross and circle frame and the diamond frame No. 2 I
stitute a valuable series. The cross corresponds in diffici

fairly closely with the Healy frame, the diamond with I

Healy-Fernald, and the circle is intermediate. These cor

SU]

lere
A f«

IS101

sions are based on about 50 comparative tests conducted i
aliens. The cross may be somewhat simplified by the examrf
if he will place in correct position one of the end pieces. If j3 n
subject has ingenuity or reasoning power he then sees ah*lf
at once the way to completion. The officer who devised t!
tests has observed that if the three are given in the o
named the location of the center piece is impressed upon'
subject and a normal will not infrequently complete the diad
in one minute, while if the order is reversed the test maf
quite difficult.

The steamboat picture form has an advantage in the cas!
immigrants in that it is an object which pleases and att
attention. Its accomplishment, depends on the senses of
and form. This test may be used to gauge the learning cap!
of the subject. It is not so readily assembled by ignorantr1
sons as might at first be expected. After having been sll
the construction two or three times, the normal illiterate us I L" 1
has no further difficulty. Subnormality may be measure!1®
some degree by the effort necessary to teach one to perfojpu
properly.

The performance tests described and illustrated do not
prise all that are available, and others may be used if ii
opinion of the examiner they are better suited for the puij
As to the relative importance of these tests, much depends
the familiarity of the examiner with the ones used. Foi
reason it is advisable that two or three of the simpler
should be selected and thorough familiarity acquired in {•
use,. reserving others for special cases. Many of them are

her

lick

wan

liror

ipssib'

tically of equal value to one trained in their use, and alte,
tests are useful when, as frequently happens, it is necesss1
reexamine a case. The mentality is low if the simpler on<pf
not well learned in a few trials, and when a case is broug1
for reexamination it is well to have in stock those with
the alien is not familiar. It should never be forgotten, hox

that the feeble-minded in many cases learn more or less © "8 ti

iraei

MENTAL EXAMINATION OF ALIENS.

1 construction, and it has been observed that some cases
h did miserably on the few tests first given were able,
• some practice, not only to do them well but to accom-
others somewhat similar with more ease than would at
have been possible.

ese examinations should never be allowed to degenerate
a mere mechanical process. They entail a high moral and
responsibility. Placing the stigma of mental deficiency
nyone is no light matter, and in case of an alien the
t may be tragical. The immigrant should be given the
it of any doubt which may arise as to his mental status
therefore regarded as normal until it has been clearly
i a that he is not.

superficial observation it might appear that the tests
iered above set too low standards, and that in consequence
, feeble-minded cases must escape detection. The above
ssion of the tests, however, will serve to emphasize the
hat certificates of feeble-mindedness are not rendered be-
an alien failed on this or that test, or because he is at a
n mental age according to a certain standard. The imrni-
is certified as feeble-minded, because his general kuowl-
retentiveness of 'memory, reasoning power, and learning
ity are severally and distinctly below normal. The feeble-
•d alien learns with difficulty, his attention may be at
he may exhibit peculiar and subnormal mental traits — all
ic-h point to a mentality which is beyond hope of much
vement. His appearance, manner, and certain stigmata
'tlier physical signs may confirm such a diagnosis. In
words, reliance is not placed on these standards alone,
issible means are taken to detect cases of mental defect.
;ht be pointed out here that the practice of having a dif-
officer examine the same individual on different days
to eliminate those temporary or accidental handicaps of
migrant in the course of his examination,
ng to the operations of the literacy test,1 opportunity for
aployment of the tests outlined above would seem to be

vided in sec. 3, chap. 29, 64th Cong., session II (Feb. 5, 1917).
of this act are quoted in Appendix A, but not the paragraphs
ig to the literacy test.

MENTAL EXAMINATION OF ALIENS.

>ver,
icy in

[S. 1
til' DC

■ til.

restricted, because of the increased opportunities which 1
grants capable of passing the literacy test have had.
practical application of this law, however, has shown that p
of limited intelligence are arriving just as before the law
into effect, though possibly in smaller numbers proportion
Some reasons for this may be given here. Children of 16
or under are not required to pass the literacy test. More
an admissible alien may bring in or send for his fatlu !(1
grandfather, if over 55 years of age, or his wife, mother, g
mother, or unmarried or widowed daughter whether or not
relative can read. Thus, the head of an illiteiate family,
self able to read and write, may bring in a dozen depen |sj
who would require the use of these simple tests during ,
mental examinations. Furthermore, one who barely sue
in stumbling through the literacy tests may have had
limited opportunities that he would require as simple m
tests as would an illiterate. The difficulty, then, of pickin
the defectives from a conglomerate mass of people of all
and of every social scale will not be materially lessened oj
method employed markedly changed by the operation of thi

from

lisei

(DliD

aide

ltiOD

sin

DIAGNOSIS IN INFANCY AND EARLY CHILDHi

ctieii,

a fee

During infancy there is little, if any, difference in the it
intellectual development of the children of ignorant and illit s
aliens and those of people in more fortunate circumstances. 1 ■'
not until after four or five years that any appreciable disE|w
is noticed because of a difference in environment. The
unfolds gradually through the mental impressions it rec
and the baby of a peasant woman is likely to get as muc 1
tention as that of her well-to-do sister. If anything, the F1
families of poor illiterate people may for the first few yea
of an advantage to the infant in this respect, because

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ame

ami

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mia

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gets througl

rephi
it r

never-ending stream of mental impressions he
tact with the other children.

It follows from what has been said that, in the menti^w
animation of very young aliens, those from all classes m
judged by the same mental tests. This simplification o
work as compared with that among older immigrants doei

to wi
10 III

MENTAL EXAMINATION OF ALIENS.

ever, make tlie task easy. The diagnosis of mental de-
ncy in infancy and early childhood presents special diffi-
es. Many children who are mentally normal are retarded
leir mental development. In addition to faulty environment
isolation, various debilitating influences delay mental
! Tth. Important among these are prolonged periods of iil-
from infectious diseases, anemia, rickets, malnutrition,

■ t disease, and pronounced defects of vision and hearing.

T!ie minds of these retarded children quickly reach a state < f

■ t %

ial development when the agencies responsible for the re-
ation are removed, but previous to this their condition

■ ly simulates amentia.

'ntal tests are therefore relatively of less importance in the
1 lination of children of this age than they are in older
ren. More dependence must be placed upon the history
Bfl physical signs, and as these two aids often give little or no
D| tance, many children under five years of age can not be
1 ified mentally until a long period of observation shows
01 capacity for development their minds may possess. High-
lb ( amentia can not, then, always be diagnosed with eer-
jj y among them, although it may be strongly suspected, and
lunger the child the greater is the uncertainty.
ra " first care in detecting defectives among infant im mi-
lt s is not to allow them to pass unnoticed at the line of
. :tion. The method of making this inspection has been fully
jj ibed elsewhere, and it is intended merely to emphasize
e a few of its details as applied to the inspection of very
jo ; children. If care is not taken with this class, imbeciles
lU( ren idiots may be missed. It is a mistake to pass an entire
pi y because the mother and one or two of the older children
■eJ irmai. Each one, especially those carried in arms, should
, #jimined for evidence of stigmata of degeneracy, cretinism,
]»[ cephalus, paralysis, muscular incoordination, twitcliings,
ther signs frequently associated with amentia. In asking
uti i;e we may discover a child two or three years old, yet un-
ms ! o walk or to talk. Even if there is no response by the
j j :o the questions, a fair insight into his mental caliber may
r ntly be obtained through his general reactions and con-

MENTAL EXAMINATION OF ALIENS.

duct. For reasons before mentioned we have not devised
special tests for this class of aliens. Those which are in gen
use for estimating the intelligence of young children are
able, and they need not be discussed here.

Profound amentia is often associated with marked defect
the senses of taste, touch, pain, and temperature. It is bee
of these defects that children so afflicted relish, apparently,
thing which may be put into their mouths, and suffer mino
juries, such as bruises, cuts, and burns, with little or no
parent discomfort. Idiots and imbeciles develop cleanly li
late, if at all. Moreover, they are very slow to learn wal
and talking. It is said that defectives seldom learn to do el
before 2 years, but many children normal mentally fail in
or the other at this age, or even older. If a child of 3
years is attentive, takes an interest in things, and plays l
rally, inability to talk should not, without other signs, be t
as evidence of defect. If both walking and talking are mart
delayed, the diagnosis of amentia may be more safely n
Their attention, memory, and other intellectual processes
plainly seen to be deficient. They are likely to have some sp
distinguishing feature, as marked stigmata or paralysis. 1
cases are easily detected, but without stigmata, abnormal r
signs, or definitely defective heredity in addition to the nu
retardation it is unsafe to make the diagnosis of mental
ciency in children under 2 years of age. Such children me
retarded because of disease or faulty education.

Abnormal listlessness, restlessness, and vicious conduct
common symptoms in feeble-mindedness. Thorough phy
examination should be made and the history taken of <
mentally retarded child encountered. By this means some (
other than mental deficiency may be revealed which acct
for the retardation or corroborative evidence of defect mi
discovered, thus making the diagnosis either certain or h
probable. In addition to the evidence already mentione
valuable in estimating the intelligence of a young child
also useful to observe the manner in which the child eats, r
to surrounding influences, plays, handles objects placed ii
hands, or does such tricks as clapping the hands. Moreov

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icati

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nna

ales

fated

vals
, alt]1

MENTAL EXAMINATION OF ALIENS. 39

rell to note the understanding of simple spoken phrases and
appreciation of subjects seen in picture books,
inet gives the average age at which children perform certain
, as follows:

hree years : Shows nose, eyes, and mouth ; repeats two
ts ; enumerates objects in a picture ; gives family name ; re-
's a sentence of six syllables,

our yearp : Gives own sex ; names key, knife, and penny ;
ats three digits; compares two knives.

ie average normal immigrant of 3 and 4 years also does
e tests. In the 5 and 6 year tests of the Binet series
,3 legitimate failures are made by immigrants from un-
rable environments. In the case of older immigrant chil-
failures in the corresponding age tests are more marked.
i in the case of normal aliens in their teens and of normal
t aliens failures in the 6 and 7 year tests are made.

REEXAMINATIONS.

^quests are frequently made by interested parties for the
animation of a certified alien with the idea of having the
ficate withdrawn. It is not unusual for feeble-minded cases,
have been certified and not deported for various reasons,
3 reexamined three or four times at intervals of weeks or
hs.

all reexaminations a study should be made of the past per-
ances of the individual, as shown by his history. In ad-
n to the tests previously used new ones, somewhat different,
Id be given. An ament who has been taught to count back-
l from 20 to 1 by rote after several weeks of study will
i fail on 25 to 1. High-grade cases who do poorly with
irmance tests may learn to do these fairly well after re-
:d examinations. Some of these tests are very simple, and,
ated elsewhere, many defectives do them with ease when
examined. It is no sign of normality, then, if an alien
is a good showing with them after five or six trials at
vals of a few days or weeks. Normal people may have some
ulty at the first trial, but after that their work is usually

MENTAL EXAMINATION OF ALIENS.

rapid and accurate. On the other hand, a defective pen
who has been taught such tests as the Healy Fernald or He
Frame may on the next day take 5 or 10 minutes in their ,
cessful performance.

In the reexamination of the insane it must be borne in n)
that, away from the care and stress of the outside woild, s<
cases quiet down and show no evidence of mental disease
the layman. It is not unusual for patients to be released f
hospitals for the insane as cured and yet be returned in a
days. Their efforts to adjust themselves to the more complies
problems of the outside world have failed, and once n
brought to light the disordered state of their minds. Such Ci
also occur at immigration stations, and the proper course
action is adherence to the diagnosis if the records show it
justified. In cases of recovery with consequent withdrawal
certificate, it should be made clear to the proper immij
tion authorities that the alien was once insane, since those 1
have once had an attack of insanity are considered ui
sirable and are mandatorially deportable.

Nothing could illustrate more clearly the matters which li
been discussed than detailed histories of what actually hapi
in individual cases which have undergone examination.
Appendix D there are given several histories of this kind. T1
case histories have been carefully selected for the purp
and a thorough examination of them in detail will amply re
the officer who is seeking instruction in this field.

INSANITY.

Like any other field the medical examination of immigri
is a specialty. Among the requisites of this specialty is a km
edge of psychiatry, and especially that phase of it which d
with the objective signs of insanity. The wider the med
examiner’s knowledge of the principles of psychiatry, the u
satisfactory will be the results.

It is regarded as neither necessary nor possible in a mai
of this kind to enter upon any discussion of general psychh
There are many excellent books upon this subject readily a’
able, and the reader is referred to them for the prosecutio

MENTAL EXAMINATION OE ALIENS.

h studies. This particular field differs from other such
Is in certain peculiarities. It is intended, therefore, simply
point out certain facts with regard to psychiatry as it is
■lied in this particular field.

Iany of the modifications in methods, etc., required in the
1 have been pointed out in other places in this manual. It
been shown that the purpose for which the psychiatric
mination of the immigrant is made differs somewhat from
ilar examinations made under other circumstances. The
ital attitude of the medical officer in such examination has
i' been the subject of comment. Attention has likewise been
■cted to the peculiar conditions surrounding the examination
immigrants and the demands made upon the examiner and
immigrant in consequence of them. In addition to these
igs mention may once more be made of the facts that, as a
, the class of people examined present certain peculiar
culties ; that the medical officer must learn to dispense with
i family and personal history ; that he must work without
uowledge of the patient’s previous environment and char-
r ; that he can not depend on family and friends for honest
rmation ; that he must learn to discriminate between na
al or racial characteristics and other characteristics ; that
oust make use at times of a foreign language with which
as only a limited familiarity ; and finally, that he must deal
i individuals who are temporarily placed under strange sur-
idings productive often of peculiar mental reactions which
■rience has shown are frequently incident to the situation—
is, physiological and not pathological.

te ability of an individual to adjust himself to new situa-
; might perhaps be considered a very fair test of his mental
ility. Such adjustment is, as a rule, achieved quite readily
lie case of properly balanced persons; and it is probably
, as a general rule, that this ability of adjustment varies
:-tly with the mental balance of the individual — the better
ualance the greater the ease of adjustment and vice versa,
a this point of view, then, the fact that the average imrni-
t is called upon to face a new, difficult, and untried situa-
possesses an added significance in that it is more or less a
of his powers of adjustment. Attention has already been

MENTAL EXAMINATION OF ALIENS.

;:iori

directed to the disadvantages of such a situation in the exar
nation of the immigrant. In another sense, however, it mig
be considered to a certain extent advantageous, since it rea’
submits the immigrant to a severe mental test, and he is se
actually in process of adjustment. It might even be said tl:
for a person of his type successfully to meet such a situation
no mean test of his mental balance. It should not be overlook!
however, that the medical examiner is not in a position to
the completion of this process of adjustment, and consequen
his judgment of the alien in this respect must rest upon a proa^,
which is in reality still going on. j,^

Reference has also been made to the fact that refined diij
nosis is not always necessary. Patients are certified as insa, ^

i sc

and the type of insanity from which they are suffering is i,
demanded. This must not be taken to mean, however, that ^
officer need not attempt to be accurate and scientific in
diagnosis here as elsewhere. Occasionally it happens that boaifu
of inquiry in certain special cases desire information as to jijji
type of psychosis and particularly its prognosis. Such inly
ination should, of course, be willingly given where possible, si'j y
it is of much importance in certain individual cases. ^

In experience not a few perplexing situations will necessai tv;
arise. The settlement of most of such difficulties will in ,'as
end rest upon the broad principles of psychiatry, and the rea| ra
must again be referred to works on that subject. Reference y
made below and elsewhere to only a few of the more conn: (ten
situations which medical officers are likely to encounter in tl y

eas'

its!

daily work.

On the inspection line, or in the examining room, the offjjtln
should closely observe and frequently question the alien wh
presented for examination. Every effort must be made|
detect signs and symptoms of mental abnormalities, and
suggestion, no matter how trivial, that would point to this illy
dition is sufficient cause to detain the immigrant for a n hat
thorough examination.

It not infrequently happens that aliens may be detainee
the station both before and after the medical examinatlng
Sometimes this detention m", be a matter of several hours. )tt
is wise to request the immigration inspectors, interpret tal

tat

MENTAL EXAMINATION OF ALIENS.

:roLS, and other employees that they return to the medical
artment any alien whose language or conduct appears to be
:inctly different from what they regard as normal. This is a
:ter of some consequence, for an alien may employ mental
ormality while undergoing the immigration examination,
peration of this kind on the part of the immigration author-
s not infrequently results in the detection of mental abnor-
ities.

a the final disposition of cases — that is, certification as to
ither they are insane or not — all obtainable facts that bear
;ctly or indirectly on the alien in question must be consid-
1. Weight must be given to the facts contained in such a
ger history as may be obtained. In arriving at a conclu-
i some of the following inquiries should be made in each

/hat happened to the alien at the port of embarkation?

/hat happened on shipboard?

'id he have lively discussions or fights with other passengers?
/hat was their behavior toward him?

/hat do traveling companions have to say?

'id he try to jump overboard?

/as he locked up? Why?

/as the alien put in the ship's hospital? What symptoms
irred while there?

/Tat report does the ship’s surgeon make? Is this report
tten?

rbat do the accompanying stewards or matrons say about
case?

! there any history from the immigration authorities bear-
upon the case?

an the medical officer who boarded the vessel clear up any
its?

rhy was the alien sent to the immigration hospital?

/hat happened in the detention room?

/hat did the alien do while passing the line inspection?
js he amenable to hospital discipline, such as bathing and
:ing on ward clothes?

o the relatives throw any light on the case?

/hat symptoms or odd doings have the nurses or hospital
•ndants observed while the alien has been detained?

MENTAL EXAMINATION OF ALIENS.

Furthermore, a number of persons, especially among those
middle age, exhibit peculiarities in appearance and convers
tion, express vague and fleeting hallucinations, show faci
mannerisms and peculiarities iu conduct which coexist wi
subnormal intelligence. All of these are symptoms of dement
rather than of feeble-mindedness. However, in the absence
histories, perhaps the most practical method of disposing
cases of this character, if after repeated examinations a d
tinction can not be made between the two groups, is to pla
them in the feeble-minded group.

It seems hardly necessary to add that where there is an e
dent physical basis for mental abnormality, as, for examp
in certain disturbances of the thyroid gland, it is always wis
to base the certificate, as may be justly done, on the mem
defect rather than on the physical. The former would place t
immigrant in the excludable group, while the latter would 1
necessarily do so.

Finally attention may here again be directed to the great ij
portance of physical and especially neurological examinaticp
in arriving at a determination in mental cases. The value
these examinations can not be too strongly emphasized, q!
frequent use should be made of books of reference.

ftlli

CONSTITUTIONAL PSYCHOPATHIC INFERIORITY

lie:

lilt

In the examination of immigrant aliens many were forme jp
certified as feeble-minded regardless of any anomalies of ch

acter they showed, which on closer analysis would have justif M

1 i,i

a diagnosis of some form of constitutional inferiority,
reasons for this were that a knowledge of the past life of
patient, which is always desirable and in 'most cases essenl
to the diagnosis of a psychopathic character, is difficult
impossible to obtain from most aliens. Moreover, a further
finement of diagnosis would often have led to the landing of
alien with undesirable anomalies of character or asocial te
encies.

Under the present law such persons are mandatorily depi
able, and where the condition can be demonstrated there islli:

Ise:

MENTAL EXAMINATION OF ALIENS.

jason why the psychopathic character should not be certified
I such, even though manifested in a mental defective.

But aside from those showing defective intelligence, there is
important group in the borderland between sanity and in-
nity who are “ failures of mental adaptation ” and have a
idency to become actively disordered. In this class are the
istitutional psychopaths and inferiors, the moral imbeciles,
j pathological liars and swindlers, the defective delinquents,
my of the vagrants and cranks, and persons with abnormal
cual instincts. The dividing line between these various types
not well defined, and for purposes of simplicity in classi-
ng the mentally abnormal immigrant they may all be included
one general class and certified as cases of constitutional
kchopathic inferiority.

pases of epilepsy, in the absence of a seizure or a lucid history
the same as required by regulations for certification, can
en be disposed of as cases of mental enfeeblement, mental
erioration, or acute psychosis, all of which are excludable
ler the law.

’here are certain suspected cases of senile dementia where
ibt arises as to certification, in which it is difficult to deter-
le whether the mental peculiarities are simply incident to
•ancing age — that is, physiological — or whether they really
stitute a pathological process. In making the discrimination
ance may usually be placed upon the existence of confusion,
itement, serious memory defects and disorientation. Sub-
s exhibiting these symptoms are certified as insane and hence
ludable. Otherwise, the certificate is for senility and the
1 n, of course, is not then included in the mandatory class.

I he exclusion of the mentally unfit being manifestly of more
iti'ortance, as a rule, than the exclusion of the physically unfit,
t lical officers should exhaust every resource properly to
t ;sify cases the symptomatology of which may be indefinite,
if ise border-line cases are classed under several designations
it will be found briefly discussed in Appendix B.

xperienees of this character are not common incidents in
p i life of the individuals under consideration, but without the
is iliarities of conduct arising in connection with such inei-
ts it is difficult to detect these cases among arriving aliens.

MENTAL EXAMINATION OF ALIENS.

This is due to the short time during which the average imn
grant is under observation and the difficulty of obtaining fro
the average immigrant a complete life history, which is
often necessary before a diagnosis of the condition can
made.

HOSPITAL MANAGEMENT OF MENTAL CASES.

rin

It frequently becomes necessary, temporarily at least,
officers of the Public Health Service to care for insane, si
pected insane, or mentally defective cases. Moreover, suspect
insane or feeble-minded aliens must necessarily be placed
hospitals pending diagnosis of their condition. Recently arm
insane aliens and public charge insane patients must also
detained until their deportations can be arranged for. In a
tion to this, some types of functional nervous disorders and so
of insanity are curable under proper institutional treatme
especially incipient cases. These should all receive prompt a
careful consideration if ultimate cure is to be expected.

Before the deportation of insane aliens confined to hospit
is permitted it is the duty of the medical officer to determ
whether the patient’s physical and mental condition is s
that he is able to travel without danger to life. Furthermc
he must certify as to what kind of medical care and spc
attention may be required by the patient during the voyj
Of course, under many conditions it is wise to defer the dej
tation until the patient is in the proper condition to travel v
or without a companion.

?■'

aio

let

THE INVESTIGATION OF PUBLIC CHARGE MEN

CASES.

The immigration law provides that at any time within
years after entry any alien who at the time of entry we
member of one or more of the classes excluded by law,
alien who shall have entered or who shall be found in
United States in violation of law, any alien who within
years after entry becomes a public charge from causes
affirmatively shown to have arisen subsequent to landing, si

MENTAL EXAMINATION OF ALIENS. 47

on the warrant of the Secretary of Labor, be taken into cus-
ly and deported.1

in determining whether an alien is in the United States in
Nation of law, the Secretary of Labor may consider medical
tificates and medical opinions from any source, but Public
altli Service officers are often called upon to report upon
■h cases, especially on appeal.

Lfter a careful examination the medical officer is required
issue a certificate stating whether or not in his opinion the
cn’s mental condition is due to causes existing prior to land-
or to causes arising subsequent to landing. When, in his
nion, he can not issue an unqualified certificate, the reason
refor should be made clear. This certificate should also
te whether the alien is able to travel without danger to life
1 whether special care and attention are required on the
-age in the event of deportation.

Vhen called upon to examine public charge cases in State
;pitals or elsewhere it will usually be found that the patient
; already been examined by one or more competent alienists
1 a diagnosis made. Due weight should be given to such a
gnosis.

1 Uthough in the certificate for insanity it is not necessary to
* te the clinical variety this should, if possible, be determined.
f * example, in considering whether the cause existed prior
a arose subsequent to landing, it is self-evident that any case
f constitutional inferiority or feeble-mindedness existed from
1 ancy. Epilepsy or the epileptic constitution may in nearly
cases be assumed to have existed since birth or to have
sen as the result of some disease or other harmful influence
^ ly in life. When the disease first manifests itself in adults,
the result of alcohol or drug addiction, it is likely that these
fits are of long duration. When injury to the head is a
tor, the time of its occurrence must be determined, but it is
Hi not to accept such an explanation for epilepsy without
bstigatlng other possible causative factors.

1 jt is now generally believed that manic depressive insanity
dementia praecox are due to an inherent weakness of the

j| 1 Section 19 of Immigration Law. See Appendix A.

MENTAL EXAMINATION OF ALIENS.

constitution predisposing to mental diseases, precipitat
causes being, by comparison, of minor importance. This
especially true of dementia prrec-ox, which is of slow evoluti
character anomalies and peculiarities of the personality of
showing themselves for years before the final breakdown,
the light of our present knowledge every case of this dise
can, with entire justice to the patient, be attributed to cau
existing prior to landing. This is also true in practically
cases of manic depressive psychosis.

Only a small proportion of cases of dementia paralyf
develop before the fifth year, and almost none within f
years after infection. It follows from this that nearly all ca
which have been in this country for less than this period sho
be certified as due to causes existing prior to landing.

Cerebral syphilis may develop in shorter time after prim
infection than dementia paralytica, but even with this psy<| 11
sis, unless the time of infection is definitely known, in net1
all cases it may be assumed with safety that this occurred '
least three years previously. Likewise insanity due to alcd J
or drugs does not as a rule arise until these poisons have t !
habitually used for years. In regard to the excessive use k
alcohol, it must be determined whether this substance has a< !t
as a predisposing cause or as the essential cause of the disej a
or is only one of many symptoms of the disease itself.

In doubtful cases it is necessary to make a thorough exam
f ion of the patient. The personal examination should ft
thorough and, if necessary, with the aid of an interpreter. le
the records in the case contain a complete mental and phys “
examination of the alien, his mental status can readily
determined. Physically, one should note the state of nutri k
the condition of muscular, nervous, and vascular systems,
should seek for evidences of trauma and of previous dised
Likewise of importance is the presence of the so-called
mata of degeneration. The point to be settled is whether
condition arose subsequent to landing.

Certain mental diseases, it is to be remembered, begin in I
ously and progress very slowly, and may even show period fc
remission, so that early manifestations of the condition >
have existed and passed unnoticed before, or for some ! te

MENTAL EXAMINATION OF ALIENS.

r, the alien’s departure from home. ' Evidences of previous
iks of mental and nervous diseases, especially of the mild
3, should be carefully sought for. Statements concerning
;arly symptoms of the psychosis can, in some cases, be ob-
:d from relatives or friends of the alien, although it must
,ememhered that relatives may intentionally attempt to
Lve the examiner with the object of preventing deportation
«r other reasons. Change of character, irritability, impul-
.ess, exclusiveness, eccentricity, unusual religious tenden-
i apprehensiveness, unusual depression or elation, memory
its, impairment of judgment, hallucinations, lessened power
he application to work, or vague physical complaints may,
carefully questioning the relatives or friends, he found
ve existed before the alien’s departure from home. The
nee of any one of the above symptoms in a marked degree,
nore especially the existence of several, may be sufficient
nee that the existing psychosis began at that time,
latives may not have taken sufficient notice of these symp-
at the time, especially if of a mild degree, and even at the
of investigation may not realize that they are a part of the
at psychosis. Very careful questioning, therefore, may be
sary to elicit them.

’ective heredity has been shown to be a factor in a large pro-
>n of cases of dementia praeeox and of manic depressive
j ity. It is also of great importance in some other psychoses.
f leral it is not a particular mental disease that is inherited
r, n unstable, neuropathic constitution, and many are the
l, ;ions that may produce such. In addition to a history of
rj ie mental diseases in parents, grandparents, or collateral
, kes of the family, evidences of the occurrence of various
;g dents, such as epilepsy, hysteria, chorea, neurasthenia,

I >ther nervous diseases, alcoholic and other deleterious
a :, criminal tendencies, mental peculiarities, consanguinity,
;veral illnesses, must be sought,
j, fegard to the alien’s early history conditions during gesta-
kysical illnesses, and mental shocks suffered by the mother
,j iHiditions at birth, such as trauma, may be of importance.
e ies should be made concerning infectious diseases and con-
8890 — 18— — 4

MENTAL EXAMINATION OF ALIENS.

vulsions in infancy, the time when talking and walking be
completion of dentition, and progress in school. Not un
monly a psychosis develops on a definite feeble-minded cons
tion. Inquiry should be made as to the existence of a prei
severe illness or accident, syphilis, excessive indulgence in
hoi or drugs, domestic trouble, grief, overwork, or mental si
The previous character and temperament of the patient
factors which may have influenced this, such as home and s
environment, are also to be investigated, and peculiar traits
be noted. In fact, any unusual condition in the past life o
alien should receive careful consideration. In the case of wc
the periods of puberty, puerperium, and menopause shoul ai
ceive special attention.

In the majority of cases diligent search will reveal a
cause for the psychosis. The family history, personal his;, 3
character of onset, symptoms and duration of the present m M
condition must be thoroughly investigated and all the 1 mi
carefully weighed to determine whether or not a prior cam lad
the psychosis exists. Here, as elsewhere, the examining c e
should carefully preserve the judicial point of view, seekil it ,
determine, with all the facts in mind, the best solution of ; is a
is often a difficult problem. ml

i lai
1 1 at

APPENDIXES,

APPENDIX A.

LAW OF 1917.

act of Congress passed February 5, 1917, provides as fol-

*****:;:

. 3. That the following classes of aliens shall be excluded
admission into the United States : All idiots, imbeciles,,
-minded persons, epileptics, insane persons, persons who
lad one or more attacks of insanity at any time previously,
is of constitutional psychopathic inferiority, persons with
ic alcoholism ; paupers, professional beggars, vagrants,
is afflicted with tuberculosis in any form or with a loath-
ir dangerous contagious disease, persons not comprehended
i any of the foregoing excluded classes who are found to
1 are certified by the examining surgeon as being mentally
fsically defective, such physical defect being of a nature
may affect the ability of such alien to earn a living.
******

9. That it shall be unlawful for any person, including
■ansportation company other than railway lines entering
nited States from foreign contiguous territory, or the
, master, agent, or consignee of any vessel to bring to
lited States either from a foreign country or any insular
sion of the United States any alien afflicted with idiocy,
ty, imbecility, feeble-mindedness, epilepsy, constitutional
•pathic inferiority, chronic alcoholism, tuberculosis in any
or a loathsome or dangerous contagious disease, and if it
ippear to the satisfaction of the Secretary of Labor that

MENTAL EXAMINATION OF ALIENS.

any alien so brought to the United States was afflicted witj
of the said diseases or disabilities at the time of foreig,
barkation, and that the existence of such disease or disi
might have been detected by means of a competent medic
amination at such time, such person or transportation :f
pany, or the master, agent, owner, or consignee of any,;
vessel shall pay to the collector of customs of the custon
trict in which the port of arrival is located the sum of|ufl
and in addition a sum equal to that paid by such alien f
transportation from the initial point of departure ind
on his ticket to the port of arrival for each and every vicjg
of the provisions of this section, such latter sum to be del
by the collector of customs to the alien on whose a
assessed. It shall also be unlawful for any such person to s
to any port of the United States any alien afflicted witj j
mental defect other than those above specifically namj
physical defect of a nature which may affect his abil
earn a living, as contemplated in section three of th
and if it shall appear to the satisfaction of the Secret
Labor that any alien so brought to the United States i
afflicted at the time of foreign embarkation, and th;
existence of such mental or physical defect might hav iSI
detected by means of a competent medical examination g
time, such person shall pay to the collector of customs
customs district in which the port of arrival is located the
$25, and in addition a sum equal to that paid by such al
his transportation from the initial point of departure im
on his ticket to the port of arrival for each and every vi
of this provision, such latter sum to be delivered by t
lector of customs to the alien for whose account assessed,
******

Sec. 11. That for the purpose of determining whether
arriving at ports of the United States belong to any
classes excluded by the act, either by reason of being g
with any of the diseases or mental or physical defects
abilities mentioned in section three hereof, or otherwj it
whenever the Secretary of Labor has received infor
showing that any aliens are coming from a country o
embarked at a place where any of said diseases are pr

ait

uti

MENTAL EXAMINATION OF ALIENS.

idemic, the Commissioner General of Immigration, with
oproval of the Secretary of Labor, may direct that such

I shall be detained on board the vessel bringing them or in
ted States immigration station at; the expense of such ves-
i circumstances may require or justify, a sufficient time to
; the immigration officers and medical officers stationed
h ports to subject aliens to an observation and examina-
uffieient to determine whether or not they belong to the
xcluded classes by reason of being afflicted in the manner
ted : Provided, That, with a view to avoid undue delay in
|g passengers or interference with commerce, the Commis-

General of Immigration may, with the approval of the
ary of Labor, issue such regulations, not inconsistent with
s may be deemed necessary to effect the purposes of this
li : Provided further, That it shall be the duty of irami-
inspectors to report to the Commissioner General of Imrni-
[i the condition of all vessels bringing aliens to United
“ ports.

11 a. That the Secretary of Labor is hereby authorized
' rected to enter into negotiations, through the Department
ii te, with countries, vessels of which bring aliens to the
>| ! States, with a view to detailing inspectors and matrons
a United States Immigration Service for duty on vessels
i ig immigrant or emigrant passengers between foreign
i and ports of the United States. When such inspectors
li atrons are detailed for said duty they shall remain in
i( irt of the vessel where immigrant passengerr are carried ;
i shall be their duty to observe such passe gers during the

I I and report to the immigration authorities in charge of
. :t of landing any information of value in determining the

lability of such passengers that may have become known
i n during the voyage.

******
s 15. That upon the arrival at a port of the United States
i i vessel bringing aliens it shall be the duty of the proper
fixation officials to go to or send competent assistants to
ir isel and there inspect all such aliens, or said immigration
i is may order a temporary removal of such aliens for exam-
i n at a designated time and place, but such temporary

MENTAL EXAMINATION OF ALIENS.

removal shall not be considered a landing, nor shall it re 15
vessels, the transportation lines, masters, agents, owner!
consignees of the vessel upon which said aliens are broug 18
any port of the United State from any of the obligations w
in case such aliens remain on board, would under the provi It
of this act bind the said vessels, transportation lines, ma:
agents, owners, or consignees : Provided, That where remo’ t
made to premises owned or controlled by the United States ®
vessels, transportation lines, masters, agents, owners, or [*'
signees, and each of them, shall, so long as detention there
be relieved of responsibility for the safekeeping of such a
Whenever a temporary removal of aliens is made the v
or transportation lines which brought them, and the ma il
owners, agents, and consignees of the vessel upon which18
arrive shall pay all expenses of such removal and all exj to
arising during subsequent detention, pending decision ol ®
aliens’ eligibility to enter the United States and until the! Is
either allowed to land or returned to the care of the line' nd
the vessel which brought them, such expenses to include 81
of maintenance, medical treatment in hospital or else\j b.
burial in the event of death, and transfer to the vessel ; the
event of deportation, excepting only where they arise und> w
terms of any of the provisos of section eighteen hereof. I n
refusal or failure to comply with the provisions hereof sb ter
punished in the manner specified in section eighteen of th ali
Sec. 16. That the physical and mental examination ler
arriving aliens shall be made by medical officers of the 1 isit
States Public Health Service, who shall have had at lea; «
years’ experience in the practice of their profession since : ret
ing the degree of doctor of medicine, and who shall cond ii
medical examinations and shall certify, for the informal! lit
the immigration officers and the boards of special inquirj it;
inafter provided for, any and all physical and mental def<| tti
diseases observed by said medical officers in any such i ;t
or, should medical officers of the United States Public !j I
Service be not available, civil surgeons of not less thai se
years’ professional experience may be employed in such lit
gency for such service upon such terms as may be pres
by the Commissioner General of Immigration, under the

MENTAL. EXAMINATION OF ALIENS.

or with the approval of the Secretary of Labor. All aliens
ving at ports of the United States shall be examined by not
I than two such medical officers, at the discretion of the
retary of Labor, and under such administrative regulations
he may prescribe and under medical regulations prepared
the Surgeon General of the United States Public Health
vice. Medical officers of the United States Public Health
vice who have had especial training in the diagnosis of
mity and mental defects shall be detailed for. duty or em-
:ed at all ports of entry designated by the Secretary of
.or, and such medical officers shall be provided with suitable
jlities for the detention and examination of all arriving aliens
ivhom insanity or mental defect is suspected, and the serv-
of interpreters shall be provided for such examination.
r alien certified for insanity or mental defect may appeal
ithe board of medical officers of the United States Public
idth Service, which shall be convened by the Surgeon General
he United States Public Health Service, and said alien may
> uduce before such board one expert medical witness at his
; i cost and expense. * * *

i ec. 17. That boards of special inquiry shall be appointed
i the commissioner of immigration or inspector in charge at
li various ports of arrival as may be necessary for the prompt
;rmination of all cases of immigrants detained at such ports
h er the provisions of the law. * * * In every case where

I alien is excluded from admission into the United States,
er any law or treaty now existing or hereafter made, the
ision of a board of special inquiry adverse to the admission
such alien shall be final, unless reversed on appeal to the
retary of Labor : Provided, That the decision of a board of
eial inquiry shall be based upon the certificate of the ex-
jining medical officer, and, except as provided in section
■nty-one hereof, shall be final as to the rejection of aliens
■cted with tuberculosis in any form or with a loathsome or
agerous contagious disease or with any mental or physical
ability which would bring such aliens within any of the
sses excluded from admission to the United States under
non three of this act.

MENTAL EXAMINATION OF ALIENS.

Sec. IS. That all aliens brought to this country in violati lie

shal

of law shall be immediately sent back, in accommodations of 1
same class in which they arrived, to the country whence they
speetively came, on the vessels bringing them, unless in the op
ion of the Secretary of Labor immediate deportation is not pr:
ticable or proper. * * * Provided further, That * *

no alien certified, as provided in section sixteen of this act,
be suffering from tuberculosis in any form, or from a loaitry
some or dangerous contagious disease other than one of quansei
finable nature, shall be permitted to land for medical treatnn
thereof in any hospital in the United States, unless the Sec
tary of Labor is satisfied that to refuse treatment would be fo
humane or cause unusual hardship or suffering, in which a
the alien shall be treated in the hospital under the superviJiur
of the immigration officials at the expense of the vessel tra: abji
porting him : Provided further, That upon the certificate of
examining medical officer to the effect that the health or safltti
or an insane alien would be unduly imperiled by immedllts
deportation, such alien may, at the expense of the appropriate iter
for the enforcement of this act, be held for treatment until stjs,
time as such alien may, in the opinion of such medical officer,
safely deported : Provided further, That upon the certificate
an examining medical officer to the effect that a rejected all
is helpless from sickness, mental or physical disability, or
fancy, if such alien is accompanied by another alien wh<
protection or guardianship is required by such rejected aliivec
such accompanying alien may also be excluded, and the mast ops
agent, owner, or consignee of the vessel in which such abase
and accompanying alien are brought shall be required to retr ra
said alien and accompanying alien in the same manner
vessels are required to return other rejected aliens.

Sec. 19. That at any time within five years after entry, £
alien who at the time of entry was a member of one or more
the classes excluded by law ; any alien who shall have ente
or who shall be found in the United States in violation of t
act, or in violation of any other law of the United Stat
* * * any alien who within five years after entry become

public charge from causes not affirmatively shown to hs
arisen subsequent to landing * * * shall, upon the warn t«

!tar

far

MENTAL EXAMINATION OF ALIENS.

ie Secretary of Labor, be taken into custody and deported.

* In every case where any person is ordered deported
- the United States under the provisions of this act, or of
law or treaty, the decision of the Secretary of Labor shall

aal.

Be. 20. That the deportation of aliens provided for in this
I shall, at the option of the Secretary of Labor, be to the
try whence they came or to the foreign port at which such
s embarked for the United States ; or, if such embarkation
for foreign contiguous territory, to the foreign port at
h they embarked for such territory ; or, if such aliens en-
I. foreign contiguous territory from the United States and
entered the United States, or if such aliens are held by
ountry from which they entered the United States not to
objects or citizens of such country, and such country re-
! to permit their reentry, or imposes any condition upon
[itting reentry, then to the country of which such aliens are
:cts or citizens, or to the country in which they resided prior
itering the country from which they entered the United
s. * * * Provided, That when in the opinion of the

fary of Labor the mental or physical condition of such alien
ch as to require personal care and attendance, the said
tary shall when necessary employ a suitable person for
purpose, who shall accompany such alien to his or her final
mtion, and the expense incident to such service shall be
yed in the same manner as the expense of deporting the
ipanied alien is defrayed. Pending the final disposal of
ise of any alien so taken into custody, he may be released
• a bond in the penalty of not less than $500 with security
ved by the Secretary of Labor, conditioned that such !
shall be produced when required for a hearing or hearings
gard to the charge upon which he has been taken into
ly, and for deportation if he shall be found to be unlaw-
in the United States.

!. 21. That any alien liable to be excluded because likely
•ome a public charge or because of physical disability other
tuberculosis in any form or a loathsome or dangerous con-
is disease may, if otherwise admissible, nevertheless be
ted in the discretion of the Secretary of Labor upon the

MENTAL EXAMINATION OF ALIENS.

(IT

giving of a suitable and proper bond or undertaking, apprc
by said Secretary, in such amount and containing such co
tions as he may prescribe, to the United States and to all Stgf
Territories, counties, towns, municipalities, and districts thei
holding the United States and all States, Territories, coun
towns, municipalities, and districts thereof harmless aga
such alien becoming a public charge. In lieu of such b
such alien may deposit in cash with the Secretary of Labor M
amount as the Secretary of Labor may require, which ami #
shall be deposited by said Secretary in the United States P<
Savings Bank, a receipt therefor to be given the person fun
ing said sum, showing the fact and object of its receipt and
other information as said Secretary may deem advisable,
accruing interest on said deposit during the time same sha
held in the United States Postal Savings Bank shall be pai ss
the person furnishing the sum for deposit. In the event of
alien becoming a public charge, the Secretary of Labor
dispose of said deposit in the same manner as if same had
collected under a bond as provided in this section. In the (
of the permanent departure from the United States, the nat
ization, or the death of such alien the said sum shall be retujtpli
to the person by whom furnished, or to his legal representat
The admission of such alien shall be a consideration foi

giving of such bond, undertaking, or cash deposit. Suit ms) yd

brought thereon in the name and by the proper law of
either of the United States Government or of any State, ujmi
tory. District, county, town, or municipality in which such
becomes a public charge.

Sec. 22. That whenever an alien shall have been nature
or shall have taken up his permanent residence in this
try, and thereafter shall send for his wife or minor
dren to join him, and said wife or any of said minor chi
shall be found to be affected with any contagious dis<
such wife or minor children shall be held, under such r<
tions as the Secretary of Labor shall prescribe, until it
be determined whether the disorder will be easily curat
whether they can be permitted to land without danger to
persons, and they shall not be either admitted or deported

MENTAL EXAMINATION OF ALIENS.

•h facts have been ascertained ; and if it shall be determined
it the disorder is easily curable and the husband or father
other responsible person is willing to bear the expense of the
atment, they may be accorded treatment in hospital until cured
i then be admitted, or if it shall be determined that they
1 be permitted to land without danger to other persons, they
y, if otherwise admissible, thereupon be admitted : Provided,
at if the person sending for wife or minor children is natu-
ized, a wife to whom married or a minor child born subse-
mt to such husband or father’s naturalization shall be ad-
jtted without detention for treatment in hospital, and with
pect to a wife to whom married or a minor child born prior
such husband or father’s naturalization the provisions of
is section shall be observed, even though such person is unable
ipay the expense of treatment, in which case the expense shall
paid from the appropriation for the enforcement of this act.
jec. 23. That the Commissioner General of Immigration

* * may, with the approval of the Secretary of Labor,
enever in his judgment such action may be necessary to ac-
nplish the purposes of this act, detail immigration officers

service in foreign countries ; and, upon his request, ap-
>ved by the Secretary of Labor, the Secretary of the Treasury
y detail medical officers of the United States Public Health
i’vice for the performance of duties in foreign countries In
mection with the enforcement of this act. * * *

5ec. 29. That the President of the United States is authorized,
the name of the Government of the United States, to call,
his discretion, an international conference, to assemble at
:h point as may be agreed upon, or to send special commis-
ners to any foreign country, for the purpose of regulating
international agreement, subject to the advice and consent
the Senate of the United States, the immigration of aliens to

• United States; of providing for the mental, moral, and
^sical examination of such aliens by American consuls or

' er officers of the United States Government at the ports of
barkation or elsewhere; of securing the assistance of foreign
i vernments in their own territories to prevent the evasion of
i laws of the United States governing immigration to the

MENTAL EXAMINATION OF ALIENS.

f;'l

iet;

:ch

iti

United States ; of entering into such international agreements
may be proper to prevent the immigration of aliens who, unc
the laws of the United States, are or may be excluded frc
entering the United States, and of regulating any matters p< l11

taining to such immigration.

*******

Sec. 35. That it shall be unlawful for any vessel carrying p;
sengers between a port of the United States and a port of
foreign country, upon arrival in the United States, to have
board employed thereon any alien affected with idiocy, iml
cility, insanity, epilepsy, tuberculosis in any form, or a loathsor
or dangerous contagious disease, if it appears to the satisfacti
of the Secretary of Labor, from an examination made by a me«!
cal officer of the United States Public Health Service, and is
certified by such officer, that any such alien was so afflicted
the time he was shipped or engaged and taken on board su|
vessel and that the existence of such affliction might have be
detected by means of a competent medical examination at suit
time ; and for every such alien so afflicted on board any su;
vessel at the time of arrival the owner, agent, consignee or mil
ter thereof shall pay to the collector of customs of the custor
district in which the port of arrival is located the sum of $
and pending departure of the vessel the alien shall be detain
and treated in hospital under supervision of immigration o
cials at the expense of the vessel ; and no vessel shall be grant
clearance pending the determination of the question of the
bility to the payment of such fine and while it remains unpai
Provided, That clearance may be granted prior to the determir
tion of such question upon the deposit of a sum sufficient
cover such fine : Provided further, That such fine may, in
discretion of the Secretary of Labor, be mitigated or remittilfs

Sec. 38. That this act, except as otherwise provided in s<
tion three, shall take effect and be enforced on and after M
first, nineteen hundred and seventeen. The act of March twenf
sixth, nineteen hundred and ten, amending the act of Februa
twentieth, nineteen hundred and seven, to regulate the imrnigi
tion of aliens into the United States ; the act of February twe
tieth, nineteen hundred and seven, to regulate the immigratl

MENTAL EXAMINATION OE ALIENS.

aliens into the United StateSj except section thirty-four
iiereof ; the act of March third, nineteen hundred and three, to
ulate the immigration of aliens into the United States, ex-
pt section thirty-four thereof ; and all other acts and parts of
ts inconsistent with this act are hereby repealed on and after
e taking effect of this act : Provided, That this act shall not
construed to repeal, alter, or amend existing laws relating
the immigration or exclusion of Chinese persons or persons
Chinese descent, except as provided in section nineteen hereof,
>r to repeal, alter, or amend section six, chapter four hundred
fifty-three, third session Fifty-eighth Congress, approved
bruary sixth, nineteen hundred and five, nor to repeal, alter,
amend the act approved August second, eighteen hundred and
thty-two, entitled “ An act to regulate the carriage of pas-
ngers by sea,” and amendments thereto, except as provided
section eleven hereof: Provided further, That nothing con-
ined in this act shall be construed to affect any prosecution,
it, action, or proceedings brought, or any act, thing, or mat-
, civil or criminal, done or existing at the time of the taking
ect of this act, except as mentioned in the third proviso of
fiion nineteen hereof ; but as to all such prosecutions, suits,
tions, proceedings, acts, things, or matters, the laws or parts
laws repealed or amended by this act are hereby continued in
ce and effect.

APPENDIX B.

QUESTIONS FOR USE IN MENTAL EXAMINATIONS.

The following questions have been evolved over a number of
irs, and have been found to be useful in mental examinations
immigrants both at the time of arrival and during the de-
sfition period. The officer will learn by experience as to which
estions or combination of questions are most suitable in a
en case :

ORIENTATION AND INSIGHT.

Vliat year is this? What month is it? What is the day of
i month? What day of the week, Monday or Tuesday ? What
.he time of day?

MENTAL EXAMINATION OF ALIENS.

What place is this? Are you on shipboard? Is this the ma
land? Who am I? What are these persons? What are
officials doing? Why do I ask you these questions? In
cabin inspection what did the doctor say to you? What did y
say to him? What did you do? Why did he send you here?

Has a change come over your mind? Do you feel as you c
last year? As you did five years ago? Do you have stran
feelings? Are you nervous? What do you mean by nervoi
Can you remember as well as you did 10 years ago? Is tlu
anything the matter with your mind? Are you crazy?

Did you always get angry so easily? Are you always friem
and happy as you now are?

PREVIOUS MENTAL DISORDER.

Does your mind work well? Four, five, or ten years ago <
you become sad and quiet for several weeks or months, duri
which time you could not think well? During such time <
you give up your work? How many of these attacks did
have? During the attack did you feel like killing yourse
Do you ever feel like doing away with yourself? Does y
mind ever become mixed so that you can’t control your actii
and speech? How long did it last? How many of such attac
have you had? Did these symptoms begin suddenly or did tl
come on gradually? Did you go to a hospital? Where wd
you during the attack? Have you ever been to a hospital
nervousness? Where did these symptoms begin? In yc
native place did you have a nickname? Are you considered
intelligent as other persons of your village? Did anyone c 1*1
you a fool?

HOME CONDITIONS.

What kind of work did yau do? Did you live in city, villa
or counti’y? What town?

What is the population of the village? How many hou
are there in the village? (Some will respond by giving
exact number of houses.) How many schools? How m
churches? How many stores?

ft!

li'

MENTAL EXAMINATION OF ALIENS.

s >id you buy provisions at the store? (Some peasant men do

I visit the stores. One man said, “ The oldest brother does
! the buying.” Some purchase tobacco only. Many women
; er go to the stores. The store question prepares the way
: the problems which involve the purchasing of different

igs.)

II tow far do you live from town? How long does it take to
k from your home to the village?

15 »id you go to school? For how long a time? Continuous or
sgular attendance? Did your brothers and sisters go to
1! id? Did you learn as easily as they did? Do you know
•e than they?

i working and repairing about the house can you do as well
;hey? Did you learn to read at home? While at home did
learn to use a pencil? (This is important in connection
•'ll the drawing from memory and copying tests.) Why did
11 not go to school?

I SPECIAL INFOKMATION.

t low many days does it require to hatch an egg? When do
i( plant corn? How many yards of cloth does it require in
i( er to make a dress? How would you make a dress?
a getting up from a recumbent position how does the horse’s
hod differ from a cow’s? In washing the steps, do you
in at the top or bottom? Why?

7hat does Easter, Christmas, Peysach signify? Give an ac-
nt of your daily routine. Arise at what hour? And then?
1 then?

THE VOYAGE.

7hy do you come to America? What happened to you dur-
the voyage? Were you sick? What was the nature of
r sickness? How many days were you confined to the
q’s hospital? Were you afraid of anything? Did you think
t you would die? Did you think that something would hap-
to the ship? Did you pray? Do you now think that some-
ig will happen to you? How do you feel now? Did the
p officials or passengers treat you well? Was anyone un-

MENTAL EXAMINATION OF ALIENS.

sur

kind to you? Did people follow you or look at you suspicion 1,11
Did you report these affairs to the ship officers? Did you ,n
tlie ship surgeon? Did you have heated discussions with
passengers? Did you fight with anyone on boaid? (Man '
and alcoholics frequently have altercations on board st
Did anything strange happen to you while you were ill? 1,1
you want to return home? (Upon arrival homesick and ®
pressed aliens have requested the authorities to send them 1 (
to their European homes.) Has anyone cabled from Europ ™l
stop your landing? Did your relatives want you to leave he •"
Do your friends know that you are coming to America?
your brothers and sisters here in America? Have you o 16
relatives or friends in America? Where are you going? V «
plans for the future have you? T

HALLUCINATIONS AND DELUSIONS IN GENERAL.

j usi

When alone do you hear strange noises or voices? Do tp
hear people talking about you? How often? What do ,rf
say? Do you have peculiar thoughts or feelings? Are ;.y,
being watched or talked about? When in a room by you: ,,
or alone on the country road do you hear voices? Do you w
a voice from your stomach? Does God talk to you? foe

While in church did you see God? the saints? (If t y(
questions are answered in the affirmative, further questio p|f
should follow, thus:) Did you see statues of saints? Die ,|c(
saints appear suddenly in front of you for a few minutes (y
then disappear? Did God come from heaven, suddenly ap iy
in front of you, and then disappear? p|)

Do you see visions? Do pictures, animals, forms, or per f|
suddenly appear in front of you and then disappear? Wlie jj(
yourself on the road does a statue or person suddenly api !r
to you and then disappear? Do people make faces at ;j js
Do you ever see flashes of light? Do you see strange tlii |
Did you see these things several years ago? t

Did you taste strange things in your food? Why do yon lt
eat? Is anyone trying to poison you? ;i

Do you smell disagreeable odors? Does anyone throw (i
agreeable fumes at you? Do you have strange feelings or

MENTAL EXAMINATION OF ALIENS.

surface? In the head? In the chest? In the stomach?
ou have electrical sensations? Does anyone arrange elec-
wires or other devices to bother you?
es any one control your mind? Do people make you do
s against your will? Do you feel as you did two years
Has a change come over your mind? What are you
ing about? What do you generally think about? Do you
nue to think or worry about the same thing? Does any
le force control your actions or thoughts? Can people
your thoughts? Can I tell what you are thinking about?
ou feel something moving inside of your head? Are you
e? Why do I ask you these questions?
ve you any enemies? Is there an organization against
Has any unusual thing happened?

what are you afraid? Are you homesick? Why are you
You look troubled, worried, and sad. Why do you look
way? Why are you disturbed so easily? (rattled) Are
easily upset? Do little things annoy you? How do you
up under disappointment? You look worried and angry,
are you angry? Are you better than the other immigrants?
3 you happy? Why do you laugh? At times do you laugh
y excessively and are unable to control yourself? Why
ou excited? AVhy did you become excited and surly on
ne or on the ship when the doctor spoke to you?
you dream? What is the nature of your dreams? Are
pleasant? Are they possible? Tell me your dreams. Do
leep well?

5 you religious? Were you always religious?

; you married? Do you want to marry? Do you care for
pposite sex? Explain.

ten you leave home where do you go? Are you fond of
ise (outdoor) ? What things interest you? Why are you
erent? Have you many friends? Have you always had
Is? Do you get along well with people? Do you like to
ith others or do you like to be by yourself? Have you ac-
ltances of the opposite sex? Are you in love? Have you
any love affairs? Are you married? How many times
you been married?

9889°— 18 5

MENTAL EXAMINATION OF ALIENS.

Are the people at home good to you? Do the farmei
fellow workmen treat you well? Do they talk about you?|
they look at you suspiciously? Do they follow you about?
are you treated by members of your family? If trouble ol
kind exists, how long has it been going on? Why did
change your occupation so often?

ii'-

S I

less

HEREDITY.

Are your father and mother living? Of what did they
Were they nervous? Were they in a hospital for the ins
Your brothers and sisters, are they well?

HABITS.

Do you masturbate once or twice a day? How many tin )
week do you masturbate? At' what age did you begin to
turbate? Has it affected you in any way? Why do you 4
Does it affect your mind?

How much beer or whisky do you drink a day? How
have you been drinking? At what age did you begin to d:
Do you take drugs? Tea, coffee? (Test reflexes, loot
tremors. Inspect facies and tongue.)

Do you talk to yourself? Do you talk or walk in your sj

SUSPECTED SEIZURES.

Do you have headaches? Do you have heart trouble, fai
spells, attacks of dizziness? Do you have falling spells or
vulsions? During the attack, do you know what is goir
about you? Are you just as if dead for a few minutes and
regain yourself again? While at work or while talking, d<
suddenly lose yourself or become as if dead, then wake ai
on about your work? Do you have strange feeling before
attacks occur? Can you tell when an attack will occur'
your arms and legs move during an attack? What do
relatives say about this matter? How do you feel after a
tack? Do you sleep after an attack? Do you pass urii|,
wet yourself during an attack? At what age did these at
begin? How many attacks have you had? Did your pa

pli

SCI

Oli

MENTAL EXAMINATION OF ALIENS.

elatives have these or other attacks? Are you very irritable
mes? Do you become very angry? Do you fight? What do
do when so excited? How often do they occur? Do little
gs worry and annoy you? What does the doctor call your
ness? What is the cause of these attacks?

euphoria and delusions of prosperity.

•e you well-to-do? Have you plenty of money? Do you
property? How much are you worth? Do you speculate?
mu intend to speculate? Are you going into business? Do
feel that you will be successful? Do you feel that some
you will be rich? How do you feel? Are you strong?
are your muscles? Can you lift heavy weights? How
ji can you lift? Can you run fast? How long would it
! you to walk from one place to another? Have you been
1 airship? Are you a great person? Have you any special
age to deliver? Are you inspired? Have you made any
ovements in your work? Have you made any discoveries?
you an inventor? Have you any inventions with you?
you show them to me? (Insane immigrants sometimes
plans for inventions and imaginary claims for property.)

- 1 plans for the future have you?

SCREPANCIES IN TIME ELEMENT AND CALCULATING POWER.

i: what age did you enter school? At what age did you leave
' >1? What employment did you have upon leaving school?
E hat age did you begin your apprenticeship in such a trade?

I hat age did you work at your trade as a regular carpen-
“ veaver, or other trade? Did you work at your trade in

II :ity or in several places? Did you work at other occupa-
' ? Name them. How old were you when you entered these
■ ent occupations? Is this your first trip to the United
1 s? How old were you when you first came to America?
s old were you when you returned to Europe? At what

lid you come to the United States upon your second trip?
to e element in regard to third and fourth visits to America
1 d be similarly obtained. A cross-examination in regard

MENTAL EXAMINATION OF ALIENS.

to the facts above obtained is now made in order to t
out discrepancies in the time element and calculating pow(
the immigrant.)

How many years did you attend school? How many j
were you an apprentice to a certain trade? How many 3
did you work as a carpenter? As a weaver? How long at (
trades? How many years were you in the city of X?
many years did you spend in the country Y, etc.? How i
years were you in America upon your first visit? Upon
second visit? Upon your third visit? After returning ]
(Europe), how long did you stay each time? How old
you now?

Are you married or single? How old were you when
were married? How old are you now? Plow many years
you been married?

How old was your wife when she was married? How c
she now? How many years has she been married?

How many children have you? Give their names and
How long have you been married? How much older is
than Joseph? How much older is Katherine than Mary?

How old are your brothers and sisters? How much olde
you than John? How much older is James than John?

When did you sail? What date is this? How many day
it require to make the voyage?

RECENT MEMORY.

(When possible to ascertain.) What did you have for b
fast? For dinner? Describe your journey from the tim<
left home. How many days by rail? How long were
detained at the port of embarkation? How long at sea? }
of ship? How many funnels did it have? What happen
you while traveling by rail? At the detention quarters'
shipboard? What port did you sail from? Did you se
this morning? (Cabin inspection.) How did you get
from the steamer? What did the passengers do just l
landing? What happened to the steamer an hour or two 1
she docked? What time did the steamer reach quarai
What time did she dock? What time is it now?

' *

••

‘

? • * * Cl1

APPENDIX C.

Vocabularies of foreign languages for use in questioning aliens :

English.

Greek.

Yiddish.

German.

French.

Italian.

What is your name?. . .

How old are yon?

Where do you come
from?

Where are you going?. -

What is your work? —

Did you ever go to
school?

Can you read and write?

Name the days in the
week.

Name the months in
the year.

Cotint from 1 to 20

Count from 20 to 1 hack-
ward.

How much is 4 and 4? . .

How much is 4 away
from 10?

What is this?

Do what I do

Draw this

Are you sick?

Come here

Go ahead

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

loIIIIIII

January

February

March

April

May

June

July

August

September

October

November

December

Poss Onomazesse?

Posson Eton Isse?

Apo pou isse?

Pou Piyenis?

Ti Dhoulia Xevris Na
Kamis?

Epiyes Pote ’s to
Scholion?

Xevris Grammata? —

Pes Tas Imeras tis
Evdhomados.

Tes Tous Minas Tou
Etous.

Metrisse apo to ena eos
to icossi.

Metrisse apo icossi kato
eos to ena.

Tessara ke tessara
possa yinonte?

Ean vghalis tessara
apo a ta dheka possa
menoun?

Ti ine touto?

Kamne Oti Kamno..

Grapse Afto

Isse Asthenis?

(Singular) Ela tho.

(Plural) Elate tho.
(Singular) P i y e n e.
(Plural) Piyenete.

Kyriaki

Deftera

Triti

Tetarti

Pempti

Paraskevi

Savaton

Ena

Dhyo

Tria

Tessara

Pente

Epta

. Octo

. Ennea

. Dheka

. Endheka

. Dhodheka

. Dheka Tria

. Dheka Tessara

. Dheka Pente

. Dheka Ex

. Dheka Epta

. Dheka Octo

. Dheka Ennea

. Icossi

. Trianta

. Saranta

. Peninta

. Ianouarios

. Fevrouarios

. Martios

. Aprilios

. Maios

. Iounios

. Ioulios

. Avghoustos

. Septemorios

. Octovrios

. Noemvrios

. Dekemvrios

Veehayst ihr?

Vee ahlt ziteihr?

Voon vah-nen koomt
ihr?

Voo-hin (gayt) fohrt
ihr?

Vohs is yre ar-bet?

Zite ihr ven ghe-gahn-
ghen in shoo-leh
(ha-dehr)?

Kent ihr lehzn oon

sbri-ben?

Rooft ohn dee teg foon
voh.

Eooft ohn deehah-doh-
shim foon yohr.
Tsayltfoon ayns bis
tsvahn-tsig.

Tsaylt tsoo-reek foon
tsvahn-tsig bis ayns.

Veefeelisfeeroon feer?

Vee feel is tseh-hen
ohn feer?

Vohs is dohs?

Toot vohs ih too

Mohlt dohs oof

Zite ihr krank?

Koomt ah-her

Ghayt (fohrt) vi-tehr. .

Zoon-tig

Mohn-tig

Deens-tig

Mit-voh

Don-ners-tig

Fri-tig

Shah-bos

. Ayns

Tsvay

. Dri

. Feer

. Feenf

. Zeks

. Zee-ben

. Aht

. Nine

. Tseh-hen

. Elf

. Tsvelf —

. Dri-tsehn

. Fehr-tsehn

. Foof-tsehn

. Zcjh-tsehn

. Zde-beh-tsehn

. Ah-tsehn

. Nine-tsehn

. Tsvahn-tsig

. Dri-sig

. Fehr-tsig

. Foof-tsig

. Yahn-var 2

. Fev-rahl

. Mart

. Ahp-rel

. My

. Yune

. Yule

. Ahv-goost

. Sen-tyahb

. Ok-tyahb

. Noh-yahb

.. Deh-kahb

Was ist Ihr Name? —

Wie alt sind Sie?

Wo kommen Sie her?. .

Wo gehen Siehin?

Was ist Ihre Arbeit?. .

Sind Sie je zur Schule
gegangen?

Koennen Sielesenund
schreiben?

Nennen Sie mir die
Tage der Woche.
Nennen Sie mir die
Monate des Jahres.
Zaehien Sie von eins
bis zwanzig.

Zaehien Sie rueck-
waerts von zwanzig
bis eins.

Wie viel macht vier
und vier?

Wrenn Sie vier weg-
nehmen von zehn,
wie viel bleibt da?
Was ist dieses?

Thuen Sie was ich thue

Zeichnen Sie dieses

Sind Sie krank?

Kommen Sie her

Gehen Sie vorwaerts. .

Sonntag

Montag

Dienstag...

Mittwoch . .
Donnerstag.

Freitag

Samstag

Eins

Zwei

Drei

Vier

Fuenf

Sechs

Sieben

. Acht

. Neun

. Zehn

. Elf

. Zwoetf

. Dreizehn...

. Vierzehn . . .

. Fuenfzehn .

. Sechzehn...

. Siebzebn...

. Achtzehn..

. Neunzehn.

. Zwanzig. . .

. Dreizig

. Vierzig

. Fuenfzig...

. Januar

. Februar

. Maerz

. April

. Mai

. Juni

. Juli

. August

. September
. Oktober...

. November.

. Dezember.

Comment vous appel-
lez vous?

Quel age avez-vous?.. -
D’oil venez-vous?

Oil allez-vous?

Quel est votre mdtier? .

Etes-vous alld k l’dcole?

Savez-vous lire et
dc-rire?

Mentionnez les jours
de la semaine.
Mentionnez les mois
de l’annde.

Comptez du nombre
un jusq’S. vingt.
Comptez en sens in-
verse due nombre
vingt jusq’S, un.
Combien font quatre
et quatre?

Combien reste-t-il de
quatre 6td de dix?

Qu’est-ce que c’est
que ca?

Faites ce que je fais —

Dessinez ceci

Etes-vous malade?

Venez-ici

Allez

Dimanche

Lundi

Mardi

Mercredi

Jeudi

Vendredi

Samedi

Deux

Trois

Quatre

Cinq

Six

Sept

Huit

Neuf

Dix

Onze

Douze

Treize

Quatorze

Quinze

. Seize

Dix-sept

, Dix-huit

. Dix-neuf

. Vingt

. Trente

. Quarante

. Cinquantet

. Janvier

. Fevrier

. Mars

. Avril

. Mai

. Juin

. Juillet

. Aoht

. Septembre

. Octobre

. Novembre

. Ddcembre

Come vi chiamate? —

Quanti anni avete?

Da dove venite?

Dove andate?

Che mestiere avete?

Che lavoro fate? _
Siete andato mai a
scuola?

Sapete leggere e scri-
vere?

Dite i giomi della set-
timana.

Dite i mesi dell ’anno. .

Contateda unofino a
venti.

Contato all’indietro da
vent’ a uno.

Quattro e quattro
quanto fanno?
Togliete quattro da
dieci quanti restano?

Che cosa e questo?

Fate quel che faccio io.

Disegnate questo

Siete ammalato?

Venite qui

Andate avanti

Domenica

Lunedi

Martedi

Mercoledi

Giovedi

Venerdi

Sabato

Uno

Due

Tre

Quattro

Cinque

Sei

Sette

Otto

Nove.

Dieci

Undid

Dodici

Tredici

Quattordici

Quindiei

. Sediei

. Diciassette

. Diciotto

. Diciannove

. Venti

. Trenta

. Quaranta

. Cinquanta

. Gennaio

. Febbraio

. Marzo

. Aprile

. Maggio

. Giugno

. Luglio

. Agoste

. Settembre

. Ottobre

. Novembre

. Dicembre

t Furnished by the interpreters at Ellis Island, through the courtesy of the Commissioner of Immigration, Dr.
2 Some Jews know only the Hebrew names of the Lunar months.

79889° — 18. (To face page 69.)

Swedish.

Polish.

Hvad ar Edert namn?

Huru gammel ar Ni?. .
ITvarifrAn kommer Ni?

Hvart skall Ni resa? . . .

Jak sie nazywacie?

Lie lat made?
Zk$d jesteScie?

Dokad jedziecie?

Hvad ar Edert yrke?. .
Har Ni g&tte i skola?. .

Kan Ni lasa och skrif-
va?

Upprakna veckans da-
gar.

Upprakna mftnader-
na i firet.

Riikna fr&n ett till
tjugo.

Riikna tillbaks fr&n
tjugo till ett.

Huru mycket ar fyra
och fyra?

Huru mycket ar fyra
fr&n tio?

Hvad ar detta?

Czem si? zajmujecie?

Czy ehodziliScie do
szkoly ldedykolwiek?

Czy umiede czytad i
pisad?

Prosz? nazwad dnie w
tygodniu.

Prosz? nazwac miesiqce
w roku.

Prosz? liczyc od jed-
nego do dwudziestu.

Prosz? liczyfi odwrot-
nie od dwudziestu do
jednego.

Cztery i cztery— ile
b?dzie?

Od dziesieciu odjqc
cztery— ile b§dzie?

Co to jest?

Gor hvad jag gor

Rita detta

Ar ni sjuk?

Kom hit

Ga framm&t

Prosze robid to co ja
robi?.

Prosz? narysowad to.
Czy jestedcie chorzy?
Prosz? przyjSd tutaj.

Prosze i§6.

Sondag

Mondag

Tisdag

Onsdag

Torsdag

Fredag

Lordag

Ett

Tw&

Tre

Fyra

Fern

Sex

Sju

Atta

Nio

Tio

Elva

Tolf

Tretton

Fj orton

Femton

Sexton

Sjuton

Aderton

Nitton

Tjugo

Trettio

Fortio

Fern tio

Januari

Februari

Marsh

April

Maj

Juni

Juli

Agusti

September..

Oktober

November. .
December...

Niedziela.
Ponied zialek.
Wtorek.

Sroda.

Czwartek.

Piqtek.

Sobota.

Jeden.

Dwa.

Trzy.

Cztery.

Pied.

SzeSc.

Siedem.

Osiem.

Dziewied.

Dziesied.

Jedenascie.

DwanaScie.

Trzynaseie.

Czternascie.

Pi?tna§cie.

SzesnaScie.

SiedemnaScie.

OsciemnaScie.

Dziewi?tnascie.

DwadzieScia.

Trzydziedci.

CzterdzieSci.

Pieddziesiqt.

Styczen.

Luty.

Marzec.

Kwiecien.

Maj.

CzernieC.

Lipiec.

Sierpien.

Wrzesien.

Pazdziernik.

Listopad.

Crudzieh.

F. C. Howe.

MENTAL EXAMINATION OF ALIENS.

ATTENTION, RETENTION, REASONING.

epetition of digits, problems, etc., which are described
where.

ibe test. Repeating digits. Counting forward and back-
ii by 2's and 3’s. Puzzles. Simple problems, such as —

’ ) If you have 20 coins and you go to the store and spend (5
[s for bread and 7 coins for meat, how many coins will you
s left?

9 If you have 30 coins and you go to the store and spend 2
s for bread, 3 coins for meat, and 4 coins for sugar, how
y coins will you have left?

MENTAL EXAMINATION OF ALIENS.

APPENDIX D.

HISTORIES OF CASES CERTIFIED AS MENTALLY DEFECTIVE

ELLIS ISLAND.

lit

In these histories a record is given of what certain al:
did on each day examined, except on the date of arrival. T
ally no record is kept of what is done on this date. As a r
the cause for an alien’s detention is his inability to count f F
20 back to 1 or to do some simple addition.

To make the histories intelligible it will be necessary to
plain some of the methods used in recording and to say s<
thing of the tests not mentioned elsewhere in the manual.

Use has been made of absurd phrases and of problems,
purposes of brevity, these absurdities and problems are refe
to in the records as “ stories.” These stories are given be
It will be noticed that some of them are taken from the \
of Binet and Simon. The five, six, and seven year old
in the Binet-Simon scale have also been freely used, and
reader is referred to the work of these authors for an expl
tion of several of the test's given.

The learning test differs from the one described in the P
Health Bulletin 90. It consists of 24 figures on one cardb<
and these figures in sets of 3 on each of 8 other cardbo
Unless otherwise explained in the histories, the alien wa
quired to find some of these sets, and the average numb<
trials necessary to attain success was recorded.

Money problems, though recorded in American money,
always given in coinage with which the alien was familiar

Where two or more answers are given to a mathenn
problem, they are set down one after the other with a cc
separating them.

‘"Washing steps” in the histories refers to the questio
you were going to wash a stair steps, would you begin at tl
or bottom? And unless the alien gave a reason for his ai
one was always asked for. Success or failure depended c
reason given.

“ Cube test, fourth line ” is similar to the four-cube te,
scribed elsewhere in the manual.

it I

nine

ige

MENTAL EXAMINATION OF ALIENS.

ABSURD PHRASES.

n unfortunate bicycle rider fell on his head and was killed ;
vas taken to a hospital, and they fear he will not recover,
he police found the body of a young girl cut into 18 pieces,
y think she killed herself.

man said, “ If I were going to kill myself, I would not do it
friday, because Friday is an unlucky day and would cause
to have ill luck.”

here was a railroad accident yesterday, but it was not a
one ; the number of deaths is only 48.

lady wanted the tail of her pet dog taken off. She was
id it would hurt him, so she decided to have a little piece
joff every day.

1 person walking in the forest stopped suddenly much fright-

I , hurried to the nearest policeman and told him he had

II seen hanging from the limb of a tree — (after a pause)

) t?

V neighbor has been having some strange visitors. He has
)( ved one after the other, a doctor, a lawyer, and a priest.
0! t has happened at my neighbor’s house?

“me boys were playing ball in the street. The ball rolled
1)1 een the hind legs of a mule and one little boy picked it up.
days later there was a funeral at his house. What hap-

you were out in a small boat five days from shore and had
>ard a box of gold and a box of bread, which box would you
V away if it became necessary to throw one of them over-
1 to prevent the boat from sinking?

man who had some potatoes to take to town put them in
r and hung them over the side of his mule. This looked
ge to him, and the weight all on one side seemed to worry
aule, so he filled a bag with stones and hung it over the
side. What would you have done under the circumstances?
ipose you and a companion were floating at sea in a small
boat, having been shipwrecked and left with two buckets
5sh drinking water. Several days have passed since the

72 MENTAL EXAMINATION OF ALIENS.

accident, and you have consumed all the water in one buds
The other bucket is still full of fresh water, your only supp
The empty bucket and full bucket are setting beside you wl
you suddenly discover that your companion’s coat is on fl
Would you pour the bucket of fresh water over him, or wl
would you do?

CASE HISTORIES.

Case i. — m. A., Italian, female, age 30; arrived August
1915 ; no schooling.

August 12 :

Fails to name days of the week.

Counting 20 to 1— fails.

Repeats 4 digits.

Cube test, fourth line— complete failure.

6+6=12.

2+3=5.

4+5=9.

6+6=16, 9.

6+7—“ I don’t know.”

3+4=5, 7.

5+5=11,10.

Healy frame— fails.

Says she has been married 21 years and is now 30 y

old.

August 13 ;

Fails to give date and year correctly ; day, month, p!

and ship on which passage was made O. K.

Names 9 months.

Names 6 days of the week; omits Wednesday.

Counts from 1 to 20 correctly ; fails 20 to 1.

Repeats 3 digits.

Cube test, fourth line — fails.

6+7=15.

5+5=10.

5+4=10.

4+5=7.

6+5=19.

5+6=15.

Aug

erfit

>; oi

All!

Aui

(

MENTAL EXAMINATION OF ALIENS.

4+4=8.

Healy frame — fails.

( August 14 :

Says she is 30 years old, was married at 21, and has been
married 17 years.

Cube test — fails.

Counting 20 to 1- — fails.

Repeats 3 digits.

6+7=9.

4+3=7.

3+5=9.

3+2=5.

3+5=7.

3+6=10.

2+3=5.

4+3=5.

i;rtified feeble-minded.

ise 2. — J. P. A., Portuguese, age 19, male ; arrived August 8,
I ; one year schooling.

August 8 :

Says there are 20 months ; names none.

Counting 20 to 1 — Fails.

5+4 — Gives up.

, 6+6=7.

August 9 :

Counting 20 to 1 — Fails.

Cube test, fourth line — Fails.

Opposites — 5 out of 8 — O. K.

10— (3+4) =5, 3.

10— (6+2) =7, 3.

6+6 — “ I don’t know.”

4+4=8.

4+5=6.

Repeats 4 digits.

August 11 :

Counting 1 to 20 — O. K.

Counting 20 to 1 — Fails.

6+7=23. 3+5=16.

3+3= 4. 2+2=3.

MENTAL EXAMINATION OE ALIENS,

2+1= 3. 3+2=5.

2+2= 4. 3+3=4, 5.

3+2= 5. 3+3=6.

4+5= 7. 2+l+3=7.

Cube test, fourth line — Fails.

Repeats 4 digits, sometimes 5.

Cross frame — Fails.

Imbecile test, same mistakes repeated, fails to cc
plete test in three minutes.

Seguin form board, O. K. in one and one-sixth minut
Names days of the week forward ; fails backwa
Says he worked on a farm for $8 the first year and f
the second.

Certified feeble-minded.

Case 3. — L. P., Italian female, age 47 ; arrived February
1916 ; no schooling.

February 26 :

Fails to give month and year correctly ; day, place, i
ship on which passage was made, O. K.

Names five days of the week.

Says she does not know, when asked to name mouths.

Counting 20 to 1 — Fails.

Repeats 3 digits.

ert

«(

lie

6+7 — 8.

3+4=5.

3+3=6.

February 27 :

Repeats 3 digits.

Cube test — Fails.

Says Christmas comes in April ; does not know why i
celebrated.

Never heard of Easter.

Differences: Horse and cow? “Both are beasts.”

Suicide story — Fails.

Ilealy frame — O. K. after being shown.

Imbecile test — Makes many senseless mistakes, but fin
succeeds.

Gold and bread story: Would keep both, but if forcei
throw away one would keep the gold.

MENTAL EXAMINATION OF ALIENS.

i 5

February 28 :

Names days of the week forwards, fails backwards.
Names 7 months.

Repeats 3 digits.

Suicide story — Fails.

Gold and bread story — Fails.

Learning test — Fails,
ij Circle frame — Fails.

Little boy story — Fails,
i Cube test — Fails on fifth line.

i Healy frame — Fails.

j “ Christmas comes in February.”
ortified feeble-minded.

me + — N. C., Italian, female, age 18; arrived February 24,
Hi ; six years’ schooling ; mother feeble-minded ; two younger
libers normal.

■ February 29 :

: Counting 20 to 1 — Fails, given three trials.

Fails to copy diamond; two trials, but one figure is fairly
good.

Copies from memory one of the Binet-Simon drawings for
10-year children, but does it poorly and requires two
views ; copies the other drawing after three different
views. Only one drawing required at a time and allowed
to look at the original about 30 seconds each time.
8+9=12.

6+7=13.

5+6=10.

6+6=12.

4+5=9.

Description of pictures — Merely enumerates objects and
fails to describe the action even when asked to do so.
Unfinished pictures — All failures.

Now copies a diamond fairly well.

Makes one mistake, afterwards corrected, in naming four

ii j colors.

Differences —

e Horse and cow? “We eat cow but not horse.”

Wood and glass? “ Glass breaks.”

Butterfly and fly? “No difference.”

MENTAL EXAMINATION OF ALIENS.

Names days of the week correctly.

Counting value of six stamps ; value, 9 cents — O. K.
Repeats four digits, but sometimes fails.

Definitions —

A chair? “It is wood.”

A table? “It is wood.”

A cart? “ It is wood.”

A house? “ It is built.”

Fails to give month, date, or day. Gives year correctly.
Names months correctly.

Fails to arrange five weights; three trials given and :
failures.

Healy frame — Gives up after trying four minutes.
Imbecile test, O. K. in one and one-half minutes, but mal
a number of senseless mistakes.

March 1 :

Gives month as January, day Wednesday (Friday), da
year, place, and ship on which passage was made O.
Names days of the week forwards, fails backwards.
Names 12 months correctly.

Counting 20 to 1 — one mistake.

20 to 0 by 2’s— 18, 16, 14, 12, 11, 10, S, 6, 4, 2.

Repeats three digits, sometimes four.

Suicide story — O. K.

Gold and bread story — O. K.

Little boy ball story — Fails.

Suicide on Friday — Fails.

Significance of Christmas — “ Christmas is a feast
cause that day is Christmas.”

Washing stairs — Would begin at the foot.

Cube test, fifth line — Fails.

13+14=24.

20— (4+2) =17.

March 2:

Healy frame — Fails in 5 minutes.
Geographic test — O. K. in 5 minutes :
mistakes.

On second trial, O. K. in 3 minutes.

numerous sense!

'ert

MENTAL EXAMINATION OE ALIENS,

Cross frame — O. K. in 8 minutes.

Morning or afternoon — O. K.

Definitions —

A fork? “It is iron.”

A door? “ It is wood.”

A window? “ It is glass.”

Three commissions — Given 2 trials and fails each time.

Put left hand on right ear — Fails.

Hold up left hand— Fails.

Show your left eye — Shows the right.

Esthetic comparison of faces — O. K.

Fails to write a sentence containing 3 given words after
about 10 minutes’ trial. Says it can not be done.
Given Rome, Pope, and church, she writes, “ Rome is
a city,” and again says it can not be done. Under-
standing of easy and difficult questions (Binet-Simon
9 and 10 year) — Fails all hut one.

8+9=18.

4+5+3=12.

20 cents — 3 eents=12.

7+6=13.

6+5+4=14.

25 cents — 9 cents=ll.

6+5=11.

9+6=15.

20 cents — 7 cents=ll.

Learning test — Average 41 trials. One set given up after
8 trials.

Hanging to tree story — Fails.

Doctor, lawyer, and priest — “ Somebody was sick.”

Repeats 4 digits.

Cube test, fourth line— Fails about 75 per cent.

This girl has had 6 years’ schooling; her mother is feeble-
minded ; two of her younger brothers examined here
are normal. She measures only about 7 years by the
Binet scale and does poorly on performance tests,
ertified feeble-minded.

MENTAL EXAMINATION OF ALIENS.

Case 5— M. C. D. G., Italian, age 48, female;
ry 24, 1916 ; no schooling.

February 24 :

Counting 20 to 1 — Fails.

6+7=16, lo.

5+4=12.

Cube test— Fails.

February 25 :

Names 4 days of the week.

Counting 20 to 1 — Fails.

Cube test, fourth line — Fails.

February 26:

Counting 20 to 1 — Fails.

Names 5 days of the week.

Names 11 months.

Repeats 3 digits.

5+5=10.

3+4=6.

5+4=6.

3+3=6.

6+5=11.

arrived

Febr

2+3=12.

Cube test, fourth line — Fails.

February 28 : , . .

Gives day, month, date, place, and ship on which pass: S

was made correctly.

Names 11 months.

Names days of the week forward ; fails backward.
Counting 20 to 1— Fails. 1

Repeats 3 digits.

Cube test— Fails to touch two blocks correctly.

Cross frame— Fails ; also fails after being shown how
put the blocks in place.

Imbecile test — Fails.

February 29 :

Compares two weights correctly.

Fails to copy a square; draws one oval and one inegi
figure.

MENTAL EXAMINATION OF ALIENS.

Game of patience (cut oblong card) — O. K.

Counts 4 pennies correctly.

Repeats sentence of 10 syllables.

Morning or afternoon — O. K.

Definitions —

A fork? “ It is a fork ; ” (asked again) “ It is silver.”
A horse? “ It is meat.”

A chair? “ It is a chair.”

A man? “A man is a man.”

A table? “ It is a table ; ” (asked again) “ It is wood.”
Fails three commissions ; forgets one of them.

Apparently knows right from left, but failed to put right
hand on left ear on three different trials ; later did so.
Esthetic comparison of faces — Fails 2 out of 3.

Description of pictures — Merely enumerates some of the
objects ; fails to describe even when asked to.

Unfinished pictures — Fails 3 out of 4.

Names four colors correctly.

Fails to copy diamond — No resemblance.

Total legs, 1 horse, 1 chicken, 1 cow — 16.

Total legs, 1 horse, 1 chicken — 16. She remembers the
question ; later, when asked again, says 8.

Total legs, 2 chickens — 4.

Total legs, 2 horses — 4.

Says she has 10 fingers. If 6 were cut off, would have

7 left.

Says she has 5 fingers on one hand. If cut 3 of them
off, would have 4 left.

Imbecile test — O. K. in 41 minutes with assistance; on
second trial, O. K. in 1£ minutes.

Healy frame (carefully shown how to put blocks in
place) — Fails even with more assistance; again care-
fully shown and she still fails. All but two blocks are
then put in place for her, and she gets these two in
after a number of mistakes. Is able to repeat the test
in two minutes’ trial, but makes many mistakes.

Repeats 3 digits.

MENTAL EXAMINATION OF ALIENS.

Cube test — Fails to touch only 3 blocks after numeri i
trials on the same moves ; does it correctly then if t
where to start.

Says she is going to her husband in Ohio. If she did
find him there, would go back to Italy, as she has 1
brothers-in-law.

Gives correctly the port of departure, name of ship, j
time at sea.

Is unable to give name of the King of Italy.

First says she would start at the foot to scrub a sf
of steps ; then says the top. Gives senseless reas
when asked why.

Gold and bread story — “ Would throw the bread aw
Further questioning — “ To save myself, would th
all away.”

Counting 10 to 1 — Can not be taught, although cards
used in subtracting.

10 cents— 1 cent=5 cents.

Says she has 10 fingers, and if she lost 1 of them 5 w
be left. Is unable to get this correctly, even when
hands are spread on the table before her and
fingers are pointed to.

She worked on a farm in Italy. Says corn is plante
September, peas in April, and potatoes in May,
grass is cut in August (all said by the interpreter 1
correct).

Says Christmas comes in December ; (signific-auce) “
is why they use it for a feast.”

Easter comes in April ; it is a feast.

Suicide story — Fails, and when questioned directly i
it, says she thinks the girl cut herself up. Later, ■
asked if one could cut herself in 18 pieces, says 11

If you made 2 cents a day, how much would you ma
3 days— IS cents.

Certified feeble-minded.

Case 6. — S. B., Italian, female, age 21 ; arrived Februar
1916; no schooling.

1
I
B

feb

MENTAL EXAMINATION OF ALIENS.

February 25 :

Counting 20 to 1 — 2 mistakes.

Cube test — Fails to learn one 4th line move.

February 26 :

Fails to give day, date, month, or place correctly.
Names ship on which passage was made,
j Names days of week forward ; fails backward.

Names 10 months.

Repeats 3 digits,
t] Suicide story — “ Nothing.”

■j Gold and bread story — “ Nothing.”

■February 28 :

Names days of week forward and backward.

Names 12 months.

Repeats 4 digits.

Counting 20 to 1 — O. K.

Suicide story — “ Nothing.”

Gold and bread story — Fails.

6+7=12.

6+6=12.

, 6+7=15.

5+4=9.

7+5=10, 12.

Learning test — Fails in 10 trials to find one set.

Healy frame — Fails.

'ebruary 29 :

Counting 20 to 1 — O. K.

6+7=14, 13.

6+5=20.

5+4=8.

i 10 cents — 3 cents=20 cents.

10 cents — 3 cents=14 cents.

| Differences —

Wood and glass? “ Both the same.”

Paper and cloth? “ Cloth is cloth and paper is paper.”
Names days of the week.

Counting value of 6 stamps (value, 9 cents) — Fails at
first ; later O. K.

0889° — 18 6

MENTAL EXAMINATION OE ALIENS,

Repeats 3 digits ; occasionally repeats 4.

Gives date and month correctly ; fails day and year.
Names 11 months.

Arranging 5 weights — Fails ; unable to grasp the idea,
Cube test — Unable to learn one fourth-line move af
repeated trials.

Ill

Imbecile test — O. K., with assistance, in 7-J minut

many senseless moves ; on second trial O. K. in 21 m
utes ; many senseless moves.

Uealy frame, first carefully shown. — O. K. in 1J minut
repeats in 40 seconds.

Morning or afternoon — Fails.

Definitions—

A chair? “ It is to sit on.”

A church? “ It is where you go to hear mass.'

A fork? “It is to eat.”

Three commissions — Fails even when prompted.

Three other commissions — O. K., slowly but correctly.

Does not know right from left.

Aesthetic comparison of faces — Fails 1 out of 3.

Fails to copy a square (three trials), draws 2 oval
ures and 1 irregular line.

Game of patience (cut oblong card) — Fails after nur
ous trials.

Repeats sentence of 10 syllables once in !' trials.

Arranges 2 weights correctly.

Place, time at sea, and name of ship on which pass
was made — O. K.

Says she is going to her sister. If she should fail to
her she would come back to Ellis Island and t
return to Italy.

Would start at the top to wash stairs (why?) “ I w<
start from the bottom.”

To make a dress, says she would need the goods, thr
and hooks. Nothing else.

Certified feebleminded.

Case 7. — A. G., Portuguese, male, age 22 ; arrived March
1916 ; no schooling.

MENTAL EXAMINATION OE ALIENS.

.larch 20:

| Counting 20 to 1 — Fails.

i Names days of week forward ; fails backward.

Repeats 3 digits.

Cube test, fourth line — Fails.

Ilarch 22 :

" Counting 20 to 1 — Fails.

r| Says he has been trying to learn, but is “thick” (point-
ing to his head). Says he has an older brother who is
“ thick ” also, but four others who are bright.

5+4=12.

3+2=5.

4+3=8.

5+3=6.

Repeats 3 digits; sometimes 4.

Names 5 days of week irregularly.

Names 10 months irregularly.

Gives month correctly ; fails day, date, and year.

Cube test, fourth line — Fails 80 per cent of trials.
Imbecile test — O. K. in 3i minutes,
iarch 23:

Counting 20 to 1 —

20, 19, 18, 16, 17,

20, 19, 18, 17, 16, 15, 14. 13, 16, 18, 19, 14, 13.

Tried to learn last night again ; says “ I am very thick.”
Total legs, 1 horse, 1 chicken, 1 cow — 12.

Counting value of 6 stamps (value 9 cents) — 20 cents.
Learning test— Average 7J trials and fails to find the last
set in 11 trials.

< Healy frame (looked at carefully before trying) — O. K.
in 50 seconds ; on second trial O. K. in 15 seconds.

Cross frame — O. K. in 1 minute.

Geographic test — O. K., 2\ minutes.

Cube test, fourth line — O. K., 75 per cent of trials. Gets
one-fifth line move after 8 trials.

| Arranging 5 weights— picks them up without comparing
! them ; when told to weigh them in his hands first, he
fails again — arranges without comparing. Seems un-
able to grasp the idea.

MENTAL EXAMINATION OF ALIENS.

Repeats 3 digits; occasionally 4, but not in order gi T
Healy-Fernald — O. K. in 5 minutes. 1(

On second trial, board turned — O. K. in 1| minutes, j 8
Imbecile test — O. K. in li minutes.

Knows right from left. ■'

Definitions — • ®

A horse? “ It is a horse.”

A table? “ It is made of wood, sometimes oa G

pine.” ^

A boat? “ It is a frigate.” ,;j C

A plow? “ It is a plow made of oak or pine.” B
Gold and bread story— O. K. I E

Suicide story — O. K.

Little boy-mule story — O. K. _ Mai

Hanging from tree — “ Could have been an objec ji

figure.” ^ f

Doctor, lawyer, and priest — O. K. C

Unfinished pictures — 3 out of 4 O. K. 1

Aesthetic comparison of faces — All failures. He k ;
what is meant by pretty and ugly and says he pi 5
the pretty, but he always points to the ugly faces £ 4

choice. _ 3

Copies a square correctly on the third trial. 6

Certified feeble-minded. 5

Case 8. — G. B., male, Italian, age 34 ; arrived March 16, 4

no schooling. ^

March 18 : 1

Was in the United States before for 6 years. Sa (
worked in Milwaukee in the “iron works” and
$200 home to Italy in 1908; was not married lIa
has 2 children now ; knows very little English ; h j
indistinct nasal voice and says it is due to some (
the midwife did to him when he was born. 1

Counting 20 to 1—20, 19, 21, 1, 2, 3, 4—20, 21, 16. (

6+6=12. I

5+4=9. i

6+7=14.

6+7—“ I don’t know.”

5+6=11. !

MENTAL EXAMINATION OF ALIENS.

Total legs, 1 horse, 1 chicken, 1 cow— 10.

10 cents — 3 cents=5 cents.

8 cents — 2 cents=6 cents.

10 cents — 1 cent=9 cents.

9 cents — 3 cents=5 cents.

1 Gives number of months as 12 ; says he does not know
them.

Gives year as 1900; date 21 (IS) ; day and month, O. K.
j Names days of week forward ; fails backward.

I Cube test, fourth line — 6 out of 9 trials O. K.

Repeats 4 digits.

! Healy frame — O. K. in 1] minutes (accident).

On second trial — Fails in 5 minutes,
larch 19 :

Names days of week forward and backward.

Names 6 months irregularly.

Counting 20 to 1 — Fails.

Repeats 3 digits.

2 + l+3=4.

5+6=7.

4+3=7.

3+7=11.

6+7=9.

5+4=9.

4+6=12.

Suicide story — Fails.

Cube test, fourth line — Fails.

Cross frame — After many mistakes, finally completes
test.

larch 21 :

Names 5 months irregularly.

Counting 20 to 1 — Fails.

Repeats 3 digits.

6+7=9.

MENTAL EXAMINATION OE ALIENS,

6+5=9.

l+2+2=7.

Suicide story — O. K.

Pack-mule story — Fails.

Coat-afire story — Fails.

Little boy-ball story — Fails.

Cube test, fourth line — Fails.

Certified feeble-minded.

Case 9. — A. C., Spanish, male, age 25 ; arrived Marc
1916 ; no schooling.

March 31:

Names days forward ; fails backward.

Counting 20 to 1 — Fails.

Repeats 3 digits.

Suicide story — “ Somebody killed her because she
money.”

April 1 :

Counting 20 to 1—20, 19. 18, 17, 16, 13, 15, 19, 17.
Counting 10 to 1 — 9, 3, 6, 7, 8, 11.

5+4=6.

4+3=5.

10 legs — 1 ieg=12.

Repeats 5 digits.

Names 6 days forward and backward.

Says there are 11 months ; names 4.

Fails to give month, day, date, or year correctly.
Counting value of 6 stamps (value, 9 cents) — 5.
Names correctly 4 colors out of 5 given ; calls j
green ; also calls green green.

Cube test — Fails to learn one fourth-line move after
trials.

Imbecile test — O. K., in If minutes.

Healy frame — Fails.

April 2:

Names days forward ; fails backward.

Counting 20 to 1 — O. K.

Repeats 4 digits.

Suicide story — “ She couldn’t have killed herself bi
I didn’t see it.”

iirti

Use

|ch(

MENTAL EXAMINATION OF ALIENS,

Significance of Christmas — Fails.

Cube test, fourth line — Fails 5 out of 6 trials.

April 3 :

Names days forward and backward.

Counting 20 to 1 — Fails.

Repeats 4 digits.

Pack-mule story — Fails.

Doctor, lawyer, and priest story— “ Some woman was
sick.”

Little boy-ball story — O. K.

6+7=17.

6+6=10.

Arranging 5 weights — Fails; one misplaced.

Cross frame — O. K.

■ Circle frame — O. K.

Diamond frame — O. K.

Knox diamond frame — O. K.

Healy frame — O. Iv.

Healy-Fernald — O. Iv.

Casuist test — O. K.

Learning test — Average, 2 trials.

April 4, 1916 :

There has been no improvement in this alien’s showing
aside from the performance tests. In 5 days he has
been unable to learn to count from 20 to 1.

Crtified feebleminded.

( se 10. — A. P., Italian, female, age 20 ; arrived April 19. 1916 ;
1+ooling.

[ April 20;

Counting 20 to 1 — Fails ; no idea how to count backward.

15+4=8.

4+3=9.

Fails to name days of week.
fApril 21:

j Names 4 days irregularly.

1 Counting 20 to 1 — Fails.

Repeats 2 digits,
u Suicide story — Fails.

■ V

MENTAL EXAMINATION OF ALIENS.

Gold and bread story— Fails.

Cube test — Fails.

April 22 :

Fails to say the days in order.

Counting 20 to 1— Fails.

Repeats 3 digits occasionally, but usually only 2.
Washing steps — Failure.

Suicide story— Failure.

Gold and bread story— Fails.

Little boy-ball story— Fails.

Pack-mule story — Fails.

Says Christmas comes in August; does not know
significance.

Significance of Easter — “ Holiday for the people.
6+7=8.

4+5=8.

2+3=6.

5+3=12.

3+4=16.

2+1=3.

Cube test, fourth line — Fails.

Circle frame — Fails.

Certified feebleminded.

Case 11. — A. M., male, Italian, age 19; arrived April 25, 1
> schooling.

April 26 :

Counting 20 to 1— Fails.

Repeats 3 digits.

Cube test, fourth line — Fails.

7+8=16

8+9 — “ I don’t know.”

April 27 :

Counting 20 to 1— Fails.

Repeats 3 digits.

Cube test, fourth line— Fails.

7+8=12

6+6—“ Nothing.”

MENTAL EXAMINATION OE ALIENS.

April 28 :

Counting 20 to 1—3 mistakes.

Repeats 5 digits.

Names days of week forward ; fails backward.

Suicide story — O. K.

Gold and bread story — O. K.

Suicide on Friday — Fails.

Pack mule story — O. K.

Cube test, fourth line — 50 per cent O. K.

Arithmetical calculations — Poor.

April 29 :

Counting 20 to 1—1 mistake.

Total number legs, 1 horse, 1 chicken, 1 cow — Fails.
Total number legs, 1 horse, 1 chicken— 9.

4+3=6

2+3=6

2+2=4

3+1=4

Names 4 days of week.

Says there are 12 months ; names 5.

Fails to give day, date, month, or year.

Repeats 5 digits.

Cube test, fourth line — SO per cent failure.

Learns 1 fourth line more after 5 trials.

Hold up left hand — O. K.

Show right eye — O. K.

Put right hand on left ear — O. K.

Healy frame — Fails in 5 minutes.

Imbecile test — O. K., in 5 minutes, with assistance.
Imbecile test O. K., in If minutes ; senseless mistakes re-
peated.

Learning test— Fails to find 1 set after 18 trials ; only 1
set given.

Comparison of 2 weights— Fails ; merely picks one up and
says, “ This is heavier.”

Copying a square— Fails ; given 2 trials and makes 2 oval
figures.

Fails to repeat sentence of 10 syllables.

mental examination of aliens.

Counting 4 blocks placed side by side— At first says 3 a)
then when urged to try again counts correctly by tone

Game 'patience (cut oblong card)-Fails after tryi
1 minute.

Certified feeble-minded. - 1Q,

Case 12.- — G. J„ mate, Italian, age 34; arrived May 5, 191

nine months’ schooling and can write.

“p.fll to give day or month correctly; does not kn
where he now is.

Knows port of departure, cost of passage, and
Repeats 3 digits.

Counting 20 to 1—0. K.

Counting 20 to 1 by 2's-One mistake.

Cube test, fourth line — Fails.

Suicide story— Fails.

M Knows the day and place; fails month and date; y
1915.

Names 8 months irregularly.

5+ 6=11
8+ 9=17
12 + 13=23, 25
13+14=37, 27
10— 3= 7
15— 5=10
25— 7=19,18
8+ 8=16
12+12=24
13+13=26
15+15=30
15+16=31
15— 7= 7 or S
20— 8=12

Cube tist, 5 fourth4 line-Fails 11 out of 13 trials. Ir
4 times in succession that he is right when
wrong.

MENTAL EXAMINATION OF ALIENS.

Imbecile test — O. K.

Healy frame — Fails in 2 minutes. On second trial after
being shown how to put the blocks in — O. K. in 40
seconds.

Healy-Fernald — Fails after 7 minutes.

Healy-Fernald (after demonstration) — O. Iv. in 14
minutes.

Ilealy-Fernakl third trial (board reversed) — O. K. in 45
seconds.

Difference: Horse and cow; six given, but lie was urged
several times to continue and give others.

.tj May S :

Unfinished pictures — 3 out of 4 O. K.

Copies a square well.

Fails to copy a diamond.

Names 4 colors correctly.

Healy-Fernald — Fails in 6 minutes. He did this yester-
day after being shown, but has forgotten that he ever
tried it before.

Healy frame — Fails in 2 minutes ; also was shown this
yesterday.

When asked if he knows why he is being held and ex-
amined, he says “ No,” and can think of no reason for it.

5+4+6=9, 15.

Counting 20 to 1 — One mistake.

Repeats 3 digits.

Cube test, fourth line — O. K. 60 per cent of trials. Fifth
line — Fails.

Arranging 5 weights — O. K.

Writes his name legibly. >

Learning test — Finds 3 of the sets with 2 trials and an-
other one with one trial.

Gold and bread story — Fails ; would keep the gold and
buy bread, if he needed any, with the money.

Put right hand on left ear — Fails.

Put left hand on right ear — Fails.

He understands and is able to repeat what is told him.

Says this is morning (afternoon correct).

MENTAL EXAMINATION OF ALIENS,

Definitions —

A horse? “ It has 4 legs.”

A c-hair? “ It is to sit down on.”

A fork? “ It is to eat.”

^Esthetic comparison of faces — Fails 1 out of 3.

Three commissions — Fails.

Three other commissions — -Fails.

Certified feeble-minded. I

Case 13. — E. K., Greek, female, age 1G ; arrived May 25, 10 1
no schooling.

May 26 :

Counting 20 to 1 — Fails.

Fails to name days of week backward.

Repeats 4 digits.

Suicide story — Fails.

Cube test, fourth line— Fails.

May 27 :

Counting 20 to 1 — Fails ; does not try to learn.
5+4=15, 14.

4+3=14.

Says she has 8 fingers, but after counting them says
If she loses 3 fingers would have 7 left ; counts
on her fingers.

Counts 1 to 20 with one omission.

Counts 20 cards correctly.

Morning or afternoon — O. K.

Comparison of 2 weights — O. K.

Game of patience (cut oblong card) — O. Iv.

Fails twice to copy a square; makes 2 irregular lines
Put right hand on left ear — O. K.

Imbecile test — O. K. in 31 minutes.

Healy frame — Fails in 4 minutes.

Counting value of 6 stamps (value 9 cents) — 8 cents5
Learning test — 3 trials on one card; others not giver]
Cube test, fourth line — Always O. K.

Healy frame ; first shown how to put blocks in pla 1
O. K. in 1 minute ; on second trial — O. K. in 20 secc
Names 5 months.

MENTAL EXAMINATION OF ALIENS,

■May 28 :

Counting 20 to 1 — Fails.

(Repeats 3 digits.

Names days of week forward ; fails backward.

Suicide story — O. K.

Washing steps — O. K.

4i 6+7=10.

5+5=16.

■May 30 :

Counting 20 to 1 — Fails.

Counting 10 to 1 — O. K.

Names days of week forward ; fails backward.

Repeats 3 digits.

Pack-mule story— O. K.

Little boy-ball story — O. K.

Washing steps — O. K.

Coat-afire story — Fails.

10— (2+2) =5.

Names 9 months irregularly.

How many fingers on both hands? Counts them and
says 10.

How many left if cut 2 off? S (counts them).

How many left if cut 11 off? 8.

How many left if cut 2 off one hand and 2 off other? 6.
Ilealy frame — O. K. — makes several mistakes.

Arranging 5 weights — O. K.

5+6=9.

3+3=6.

\ 3+4=14.

5+4=8.

4+3=9.

Cube test, fourth line — O. K. : fifth line, fails.
Healy-Fernald — Fails in 5 minutes ; on second trial, after
being shown how to put the blocks in place, O. K.

Tune 1 :

Counting 20 to 1 — O. K. promptly with no mistakes.

Admits she has been studying this ever since arrival.
6+7=12.
i 3+2=5.

MENTAL EXAMINATION OF ALIENS,

5+4=10.

5+3=16, 13, 10.

Counting value of 6 stamps (value 9 cents) — Fails at
a long trial and senseless figuring. ,

Gives day of week correctly ; fails month and year.
Names 4 colors correctly.

Esthetic comparison of faces — Fails 1 out of 3.
Unfinished pictures — 3 out of 4 O. K.

Cube test, fourth line — Always O. K.

Healy frame — Fails in 5 minutes ; was shown how to

!«i

(

this and succeeded in doing it before.

Imbecile test — O. K. 50 seconds.

Geographic test — Fails in 7 minutes; on second ti
after being shown — O. K. in 40 seconds.

This girl was a seamstress. She says “ My father
my father’s brother’s daughter, my cousin, came (
with me.”

June 2 :

Alien was asked her age and replied 12; told that it
recorded as 16, she maintained that it was 12. A
minutes later she gave her age as 16 and denied i
she had previously claimed it was 12.

5+5=15.

5+2=16.

5+2=10.

Is told to place her hands on the table before her.
then counts 5 fingers on one and 5 on the other
says both together make 10. Then asked how mar
5 and 5, she says 15.

Certified feeble-minded.

Case Ht- — A. P., Greek female, age 20; arrived May 29, 1!
no schooling.

June 1 :

Counting 20 to 1 — Fails to try.

6+7 — Fails.

Repeats 4 digits.

Cube test, fourth line — Fails.

MENTAL EXAMINATION OF ALIENS,

fune 2 :

16+7=14.

Counting 20 to 1 — Fails.

Names days of the week forward ; fails backward.

Cube test — Fails,
i |'une 3 :

f Counting 20 to 1 — Fails.

Repeats 4 digits.

, Names days of the week forward; fails backward.
u| Suicide story — O. K.

6+7=14.

- 7+8=9.

I Cube test, fourth line — Complete failure.

Washing steps — O. K.
une 4 :

Cross frame — O. K. in 31 minutes; on second trial O. K.
in 15 seconds.

i Cube test, fourth line — O. K. 3 out of 6 trials.

I Is unable to tell time.

Arranging 5 weights — O. K. 2 out of 3 trials.

Counting 20 to 1 — Fails.

Repeats 4 digits.

8+8=16

8+9=13

7+7=lS

5+6=4

10 — (2+2) =6 (counted on fingers).

10 cents — (1 cent+5 cents) =5 cents, 4 cents.

1 12 — (1+1)=7, 8, 10
1 12— (2+2)— Fails.

Healy frame — O. K. in 2 minutes; on second trial O. K.

in 15 seconds,
tne 5 :

i! Counting 20 to 1 — 5 mistakes.

Counting 10 to l—O. K. (counted on fingers).

'i Repeats 4 digits.

[ Fails to name days of the week backward.

■ 6+7=8

MENTAL EXAMINATION OF ALIENS,

3+2=5

5+3=15

6+6=12

6+7=15

4+3=7

3+5=8 (counted on fingers). ^

Names 8 months irregularly.

Cube test, fourth line — Fails 9 out of 12 trials.

Circle frame — Fails in 5 minutes.

Casuist test — Fails in 5 minutes.

Coat afire story — Fails.

Certified feeble-minded.

Case 15. — C. T., English, male, age 17, arrived May 15, 191

Sister of alien says : “ Mother has been in a hospital for
insane for 12 years, and the first symptoms manifested tl
selves shortly after Charles was born. Mother also had
child stillborn and one miscarriage. Brother was always t
ward ; although in public school in Chicago and in several pri
schools in America and England, he never advanced beyonc
.fourth grade.”

Alien says he got along poorly at school; attended in Ann 1
for five years and then returned and was a pupil in a pri
school for two years ; was put in the second grade, and alth ’
he was at school every day he did not get above this gr
says his sister thought it would be better for him to stop s<
and work on the farm.

Counts 20 to 1 correctly.

Repeats 5 digits.

8+9=17 1

100—7=94

5+4+6=14 1

14+13=27

20—7=13

Names months correctly in 12 seconds.

Gives day, date, month, and year correctly.

With what countries is England at war? “ Englai
fighting Germany, Austria, Turkey, and Bulgari
Name the countries helping England: “France, Ri
Australia, and Serbia. '9i

MENTAL EXAMINATION OF ALIENS.

Is Italy in the war? “Italy is fighting Germany.”

Is Japan in the war? “Japan is not fighting.”

Cube test, fourth line — Correct.

Suicide story — Failure ; says “ She shouldn’t cut her-
self up.”

Jay 16:

Alien says his Uncle Charles’s wife is also in the insane
asylum. He does not know whether his Uncle Charles
is a brother of his mother or father, although his name
is Charles F. (Father’s name is Philip F.)

Since these names are the same whose brother would
you think your Uncle Charles must be? (Hesitating
and looking up inquiringly) — “My father’s, would it
be?” Why not your mother’s? “Yes; I guess it must
be hers.”

On further questioning in regard to his schooling, says
he thinks he was 8 years old when he first went to
school. Where? “ In Chicago.” How long did you go
there? “ I don't know if it was one or two years.”

6+6=12.

15+15=30.

35—7=29, 28.

S+9=17.

13+14=27.

64—22=42.

15+16=31.

100 to 0 by 5’s. Done very slowly but correctly.

Is able to construct a sentence containing three given
words.

Difference, horse and cow. — Cow has hoofs on its feet,
has horns, has eyes, gives milk. Horse’s tail has lots
of hair on. Cow’s has not much on. Cow chews food
differently. (Urged to continue several times while
giving these differences.)

Difference between a lie and a mistake. — No differences ;
in one case you don’t tell the truth and in the other
it is wrong.

9889°— 18 7

MENTAL EXAMINATION OF ALIENS.

Difference, child and dwarf. — Dwarf has more hai
its head and child has smaller shoes on its feet.

What do we mean when we say “ The early bird cat
the worm? ” “ The first bird out — that wakes up fii
when it runs after and catches it.”

Ethical question : Find $10 bill — I would give it
take it to police station and find whom it belonge

Difference, charity and kindness. — One means to be k
charity means to cheer up.

Learning test. — Very well done.

Cube test, fourth line. — 6 out of 8 trials correct.

Geographic or jigsaw test. — O. K.

Healy frame test. — O. K.

Certified feeble-minded.

Case 16. — H. R., English, male, age 19; arrived .Tune (1,
June 6 :

“ I had a fall when 12 years of age and was uncons<
for one hour ; that fall kept me from learning,
didn’t go ahead in school. They gave me hair-dre
work so I wouldn’t have to bother with reading
writing.”

12+12=18.

15+15=28.

June 7 :

Had nine years’ schooling; was in the first grade; ui
to pass examinations for the higher grades.
Suicide story. — My word, but that was a rotten me;
Repeats 4 digits.

8+9 — 17, ain’t it?

15+15=25.

Healy frame. — O. K.

Cross frame. — Four minutes ; many mistakes ; fi y,
completes test.

Circle frame.- — Fails.

Coat-afire story. — I’d throw the bucket of water ove
head to put it out.

MENTAL EXAMINATION OF ALIENS.

une 8:

ISays he went to school 9 years ; started at 12 and stopped
at 14 ; sticks to this in spite of repeated questioning.
Explains his backwardness at school by a fall and says
the doctor told his mother he would “ come all right all
of a sudden,” and that he “ is beginning to get more
sense now.” Says he has been working at hair dress-
ing for nine years ; started at 14 and is now 19 years
old (repeats this discrepancy over and over). Says

{the doctor said that hair dressing did not require any
reading and writing. Says he was rejected for the
Army seven times ; went to one recruiting station six
times and to another one once. Knows that England
is fighting Germany ; is unable to mention any other
enemy. Says Turkey is helping England ; can not
think of any other allies of England, but after a long
time, mentions Japan as “ going against Germany.”
Copies a diamond correctly.

Description of pictures — O. K.
i Unfinished pictures — 3 out of 4 O. K.

Names four colors correctly.

Differences —

Wood and glass? Wood is stronger than glass.
Paper and cloth? Paper tears and cloth does not.
Horse and cow? Cow gives you milk and a horse
drives you ; a cow is different shape ; the legs,
body, and head are different. Horse’s head is
larger and more pointed.

Counting 20 to 1 — Complete failure. Gives up even after
an example by counting all the way from 20 to 1 is
given him.

[Names days of the week.

Counting value of six stamps (value 9 cents) — 11 cents.

On second trial — O. K.

( Names nine months irregularly.

Gives day of week correctly ; fails to give month, date, or
year.

Defines objections in terms of use.

100

MENTAL EXAMINATION OF ALIENS.

25 shilling— 9 shillings=22 shillings. Second trial — j ;
would leave 6.

Arranging four weights — Fails four times in success!
Cyclist dead from fall story — It lies with the doch 1
see whether he will recover or not.

Railroad accident — I don’t know that.

Suicide Friday story — He could do it on Thursday 1
cause Friday is an unlucky day.

Cube test, fourth line — 3 out of 6 trials O. K.

Imbecile test — O. K. in one minute.

Ilealy Fernald — O. K. in three and one-fourth mir
He takes an interest in this and says, “ I have had
ing games with blocks in Liverpool before.”
5+4+6=15.

8+7+6=21.

14+13+2 — Gives up. 1

Certified feeble-minded.

Case 17. — M. B., Italian, female, age 18 ; arrived May 31, !
no schooling ; slight speech defect.

June 1 : I

“ I did not want to go to school ; mother wanted me 1
but I did not want to go.” (Pressed further.) “ ]
afraid the teacher would hit us.” Groans, moans 1
sighs. Why do children go to school? “ I don’t ki
Counting 20 to 1 — O. K.

20 eggs — (3+3) — Take 3, leaves 17, then take 3 i 1
leaves 14. 1

20— (3+3+3) =18.

Repeats 5 digits. *

Copies diamond correctly. I

Cube test, fourth line— 2 trials out of 6 O. K.

Very nervous, excited, trembling; responds without t 1
ing. : !

June 4 :

Counting 20 to 1 — O. K. ; two mistakes corrected.
6+7=13. <

14+13=23, 27. 1

7+6+8=22. 1 ■

MENTAL EXAMINATION OF ALIENS,

101

. ; 8+9=17.

- 5+4+6=15.
jl 4+3+1+5=13.

■ Repeats 5 digits.

Put left hand on right ear— Fails.

Put right hand on left ear — Fails.

Hold up left hand — She puts up the right.

Hold up right hand — She puts up the left.

Definitions—

A horse? It is a horse.

A chair? It is to sit on.

A fork? It is a fork.

A house? It is four walls.

Morning or afternoon — O. K.

Aesthetic comparison of faces — O. K.

Three commissions — Has to be prompted after the per-
formance of each one and then does not do them prop-
erly, but apparently remembers what was told her.

Names four colors correctly.

Imbecile test — O. K. ; no mistakes.

Geographic test — O. K. in 60 seconds ; repeats in 50
seconds.

Healy frame — Fails. Shown the blocks in place twice,
then carefully shown how to put them in ; she again
fails, using no judgment.

Unfinished pictures — All O. K.

Learning test — 8 trials on first card, then other cards
1, 2, 7, and 3 trials.

Cube test, fourth line— 50 per cent of trials O. Iv.

Healy frame — She is again carefully shown how to put
the blocks in. Fails in 4 minutes.

I Does not repeat sentence of 10 syllables.

Suicide story — Fails. Explains how he could cut himself
up into 18 pieces by cutting off part of each leg and
then a little more each time.

Gold and bread story — Fails.

Little boy mule story — Fails.

This alien worked at home as a seamstress.

102

MENTAL EXAMINATION OF ALIENS.

Certified feeble-minded.

Case J8. — F. G., male, Italian, age 24; arrived June
no schooling.

June 5 :

Counting 20 to 1 — O. K.

Counting 25 to 1 — Fails.

6+6=12.

8+8=16.

10+11 = 15.

10+10=20.

6+7=14.

8+9=18.

Cube test, fourth line— Fails 4 out of 6 trials. H
peculiar method of performing the test, in wliic
uses both hands.

Arranging 5 weights — Fails.

Repeats 5 digits.

Alien makes a number of foolish movements. Say
came here to make money and will then get mar
“ If my girl goes back on me, I will get another
I can get them easily.”

June 6 :

Cube test, fourth line — Fails 4 out of 5 trials.

Ilealy frame — Fails in 7 minutes.

Geographic test — Gives up after 5 minutes.

Healy-Feruald — Fails.

Imbecile test — O. K. in 6 minutes, first trial ; on se
trial, O. K. in 3 minutes ; makes many foolish mist;

4+3+2=15.

2+l+3=6.

(

rli:

lie

;i:

Fel

(

5+4=10, 9.
6+7=14.

Counting 20 to 1 — O. K. Says the doctor taught him 1
night.

Counting 30 to 15 — O. K.

Names days of week forward and backward.

Names 8 months.

Denies delusions and hallucinations.

MENTAL EXAMINATION OF ALIENS.

103

Tune 7 :

Counting 20 to 1 by 2’s — Fails.

Repeats 4 digits.

Cube test, fourth line — Fails; does his usual character-
istic moves.

Names 11 months.

Suicide story — O. K.

7+8=16.

7+8=13.

8+8=16.

5+5=10.

5+6=11.

I 9+7=17.

| 6+9=15.

Cross frame — Fails.

Circle frame — Fails.

Healy frame — Fails,
rtifled feeble-minded.

se 19. — Z. G., Italian, female, age 18; arrived February 26,
i; no schooling.

February 26:

Fails to give day, date, and year correctly.

Gives month, place, and ship on which passage was made
correctly.

Names days of the week forward ; fails backward.

Names 11 months.

Repeats 3 digits.

5+6=8.

4+2=8.

2+2=6.

4+4=9.

1+1=2.

i Cube test, fourth line — Fails.

February 27 ;

' Imbecile test — Fails in 5J minutes; senseless maneuvers
to get the blocks in place.

Healy frame — Carefully shown twice how the blocks are
put in place. Five minutes’ trial each time — Fails.
Cube test — Fails to learn to touch 3 blocks after a num-
ber of trials.

104

MENTAL EXAMINATION OF ALIENS.

Comparing two weights (81 and 9 grams) — She pick;
the lighter one without touching the other and says
heavier. Given one in each hand and told to w
them, she again chooses the light one.

Repeats sentence of 10 syllables 2 out of 3 trials.

Counts 4 pennies on the second trial ; at first corn
them as 3.

Game of patience (cut oblong card) — Fails after 3 )
utes’ trial ; shown the solution then, and again fails

Copy of square — Makes 2 small oval-shaped figures.

3+2=8.

4 cents+2 cents=9 cents.

3 cents — 1 cent=10. When asked what she was tol
do she replied, “John is a good boy” (part of a
fence given her to repeat several minutes before).

./Esthetic comparison of faces — All failures.

Does not know right from left.

Says she has 10 fingers ; if she lost 8 there would !
left.

Three commissions — Does only one; when prompted,
another, but fails when prompted again to do the tl

Repeats 3 digits once in 3 trials.

Mother says the child did not walk until 27 months
and was more than 3 years old when she began to i
Certified imbecile.

at.

jiii

!.r

at
ital
n
id;
i?
i in
lly
itr
if

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Hill

jllti

I I’ll

Case 20. — R. W., Polish, male, age S; arrived May 24, I f

1 $6

no schooling. ^

May 24: n

Is able to say a few words only. The mother speak in
some injury or illness when the child was born ;

definite). She has, besides this child, two noi i.

children with her. +

May 25, 1916: Us

Mother says his mental condition was caused by ne$ *
on the part of the midwife at his birth. There wa ,j(
operation on his abdomen when 18 months old.

He feeds himself and goes to the toilet of his own voli it
but can do no tests. He is affectionate, stubborn, ’
foolish. [0

Certified imbecile.

MENTAL EXAMINATION OF ALIENS.

105

APPENDIX E.

3')RIES OF CASES CERTIFIED AS INSANE AT ELLIS ISLAND.

Oing to racial peculiarities, it seems advisable to portray
;tin types of reaction which do not normally belong to a par-
•uir race and which when present in a person of that race
afitute an abnormal mental state.

13 following three (3) cases were certified as insane because
tiir attitude and general reaction :

C$e No. I. — Female, single, age 39 ; nativity, Ireland ; II
is Alien was sent to Ellis Island because she struck an im-
gition inspector with her umbrella. On arrival she refused
mke a statement explaining her conduct and demanded her
•diate release, saying that she wished to proceed to her
nation without further annoyance. She was sent to the
tal for observation. On admission she refused to conform
e ward routine in any degree. She threatened to give the
tcian the same treatment she had accorded the inspector,
mg her residence in the hospital she was arrogant, irritable,
faultfinding. She occasionally assaulted a nurse and fre-
:ly met the physician with a tirade of abuse, blaming him
er continued detention. She refused to discuss the condi-
which brought about her admission, other than to say that
ras sorry that she struck the inspector. She had no appre-
>n of the gravity of the situation and would not listen to any
.nation. No amount of questioning could elicit any hal-
ations or delusions. This woman was undoubtedly insane ;
idiole attitude and manner were the same as one sees in the
loid form of dementia praecox.

se No. II. — Male, single, age 23 ; nativity, Austria ; Hebrew,
■lass. Alien was turned aside during line inspection for
.cal examination. He refused to remove his clothing in the
fining room, and was sent to the psychopathic ward for
B vation. He made no great objection to the routine admis-
p formalities and gave very little information concerning
Iblf. Throughout his sojourn in the hospital he was as-
Ive, irritable, arrogant, and egotistical. He resented all
Ids at examination, refused to respond to questioning for
puost part, offering in explanation that he was a serious-
fed young man and couldn’t be bothered answering foolish
|:ions. He maintained this attitude during the three weeks
lunained in the hospital.

Cse No III. — Male, married, age 45; nativity. Greece; III
|. On the line inspection alien was suspected of being
Reminded and was accordingly turned aside. In the even-
t'ollowing his arrival he occasioned considerable trouble in

106

MENTAL EXAMINATION OF ALIENS.

the detention rooms, and was sent to the psychopathic pavi'i*
On admission he was somewhat agitated. The next dav he F

restless and troublesome, annoying the attendants from ,
to time with requests for his release. When this was ref I™
he went about the ward in tears, wringing his hands and J111
ing “ Patras to-morrow morning, Patras to-morrow morn f
Then for two or three days he seemed quite normal. Arf .
amination at this time brought out no evidence of mental d> |erl:
or disorder. Thereafter, however, at intervals of two or tif01
days, he went about the ward crying “ Patras, etc.” On IP
occasions he seemed depressed, apprehensive, and fea I®
Questions were often answered irrelevantly, and he imp]J,a
the other patients, attendants, and even visitors to intercede*"1
him 1 51

It now seems appropriate to cite a few cases in which
general reaction for the first few days gave no indicatio !i
mental disorder.

Case No. IV. — Male, married, age 45 ; nativity, Nicara
On arrival alien showed marked evidence of organic dis
of the central nervous system. He discussed his conditio
some length and stated that it had been diagnosed in his
country as organic disease of the central nervous system,
progressive. He readily cooperated in the examination, i
a very good impression, and was quite pleasant and agree
He was kept in the detention ward about three days and
there was a decided change in his attitude. He gave ^
to many persecutory ideas, and regarded his detention i
part of a long-standing conspiracy against him. He was
to the psychopathic ward, and while there wrote a liistor
his life, showing that he had been the victim of various p>
cutions extending over a period of years. He traveled :
place to place, but without avail; where he went, his
mentors followed. He had a very well systematized delusi
trend.

Case No. V. — Male, single, age 40; nativity, Germany;
class. Alien was blind, and, being unable to care for bin
or make his way around, he was sent to the hospital until
time as there was final disposition made of his case. On
mission there was nothing in his conduct or manner to
one to suspect the presence of a psychosis. Everything
done to make him comfortable, and he seemed to appreciat
At the end of three days, however, he became quite dis
tented. He gave expression to ideas of persecution and
sent to the psychopathic ward. He stated that he had
annoyed and persecuted for about three years. He felt s
thing in the nature of electric shocks, caused by a supera
dance of concentrated thought transmission and thought-pic

led

MENTAL EXAMINATION OF ALIENS.

107

u missions. He also had many ideas of a sexual nature.
Iras the subject of various experiments to test his man-
o etc. His delusions were fairly well systematized and
?i?d to center around the period when he had declared his
|tion of becoming an American citizen.

Cse No. VI. — Female, single, age 22; nativity, Russia; III
is Alien was reported by ship’s surgeon as suffering from
aria. On admission she was quiet and orderly, showed no
$ of hysteria and no evidence of mental disorder. She ac-
i;ed for her illness on shipboard by saying it was due to
§ea trip. She made a normal impression for about three
y after which time she was noticed talking to herself and
j;dng occasionally. Mental examination at this time, how-
e was negative. Later she was often seen kneeling in an
tilde of prayer. After a stay of about two weeks in the
s tal she admitted hallucinations and delusions of a religious

I’e.

■e following cases are cited to show that while the general
iide and manner may be normal and statements made may
all the earmarks of facts, the general trend of conversa-
|s very often indicative of mental disorder :

Jie No. VII. — Male, married, age 60 ; nativity, Ireland ;
|lass. Alien told a well-balanced story of the wrongs to
he had been subjected by relatives. He came to America
tie first time in 1901, married, and took his wife back to
d. His brother-in-law, who lived in Ireland, did not ap-
of the match and made many attempts to secure his
J’s property. His wife had some trouble with her own
ves, and after a six months’ stay in Ireland returned to
ica. The alien remained behind for 13 years and then
led to come to the United States to join his wife. There
lo way of establishing the truth or falsity of his story, but
s held for observation. For several days after admission
|ng unusual was noted in his conduct. He told the same
, only somewhat more elaborate, in which he included his
,5 cousins and many friends of his wife’s family. He had
'boycotted in many places, and while he contended that the
reason for his second coming was to join his wife, he
n:ted that he also hoped to escape the boycotting. After a
in the hospital he began to suspect those about him. He
hat the other patients in the ward knew his story, and
Id the physician that he had heard two or three of them
ig about his troubles and saying that he should be cut up
d brown out of the window. This case is cited to show that
I the alien had a well-defined psychosis, the story he told
pe first day of his detention seemed so plausible that with-

108

MENTAL EXAMINATION OF ALIENS.

out further observation one would be inclined to give him !'i!
benefit of the doubt and allow him to go on his way.

Case No. VIII. — Male, single, age 25; nativity, Ireland; iji
class. Alien appeared mildly depressed on arrival and jai
held for further examination. He gave a history of mastui s
tion covering a period of three years, from 15 to 18. After :t
continuing this practice he was subject to nocturnal emissf. ia
and this, he says, caused him to be depressed from time to ti k
He consulted two physicians and they advised him to get r ;«
ried. In this case the sexual irregularities occupied the f :i
ground of the picture. Further questioning brought out vari.iil,
hypochondriacal ideas. He took absolutely no interest in
surroundings and showed no tendency to mingle with the ot)
in the ward. He moved about listlessly and was often noted
ting for hours gazing vacantly into space. At times when q
tioned, he seemed confused, did not have the situation wel
hand, and was vague and indefinite concerning his plans for
future. He admitted that he was low-spirited and worried
reasons other than his sexual troubles.

Cases with these sexual disorders are frequent in prr "
practice, in genito-urinary clinics, and are commonly met ^ is
in marine hospitals. The above case is cited to show tha |
many instances the sexual difficulties are merely a veil cove «
the underlying psychosis.

During the course of a full day’s work, when 5,000 in
grants arrive, there will be seen more or less excitement ,
confusion on the part of the aliens incident to landing
meeting friends, etc. To a certain degree this is nor [||(
and the majority adjust themselves almost immediately to
new conditions. However, in many instances the confusi |
episodes are prolonged, and these are the cases in which fur
observation is necessary. The following two cases show .
advisability of further detention and thorough examination ,,

Case No. IX. — Female, single, age 40; nativity, Germany; ^
class. Alien had been in the United States on two previous (
sions. On the third trip she seemed somewhat confused
readily admitted that she was upset from the voyage. 11
contended, however, that she would be all right when she rea 11
Minnesota. She was detained and during the next few < |
gave utterances to well-defined delusions. She stated that
real reason for wanting to go to Minnesota was because of
tain “ secrecies ” which were in her body and would not < ®
out until she arrived there. A second reason was that n
wanted to see a physician there who could settle all her jj
culties, as he performed miracles.

MENTAL EXAMINATION OF ALIENS.

109

| Wise No. X.— Male, married, age 69 ; nativity, Ireland ; III
las. Alien presented the physical enfeeblement incident to
dmced years. In the examining rooms his actions were not
ibrent from those of the other aliens about him. A few ques-
ts showed that he was somewhat clouded mentally. He was
■I to the male detention ward for observation. While there
■ad to be cared for like a child, could not find his bed, was
niless about his appearance, rather untidy in dress, cried, and
iled to himself a great deal. He had no idea of time or place,
9id not recall the names of his children, etc. This was very
Inly a case of senile dementia.

APPENDIX F.

BLANK FORMS, ETC., USED AT ELLIS ISLAND.

word or so might be said regarding certain usages and
is at Ellis Island which have proved of value,
here it is necessary to handle a large number of people
king foreign tongues among strange surroundings, some
em of distributing them must be devised which is foolproof,
t the preliminary line inspection a large number of aliens,
1 have been chalked, must be turned aside for further ex-
aation, and their distribution is likely to result in much
usion unless care is taken to avoid it. It has been found
e satisfactory to make use of small cards of different colors,
i being checked with the examining officer's initials. These
simply handed to the immigrant and he is motioned to the
tr. The color of the card indicates to the attendant at the
p- what disposition is to be made of him. For example, if
Immigrant who has been chalked on the line as a mental
liect is found at the secondary preliminary examination to
iormal mentally, he is given a certain colored card, checked
i the doctor's initials, and motioned to the door. There he
ireeted to the immigration division, and the medical divi-
c is through with him. If it is desired that he undergo some
her examination for physical defects, he is given another
ored card, similarly checked. When he arrives at the door
(evill then be conducted to the physical examining room. If

110 MENTAL EXAMINATION OF ALIENS.

he is to go to the hospital, this is accomplished in a sim
manner, and so on. The method is simple and effective.

An immigrant who has been chalked and then released
preliminary examination is at once turned over to the immi:
tion division and a record is made of the matter, but no hist
of the case is kept. The mental cases which are held for
ther examination are recorded on the card which is sh< K
herewith. At one time we used a card which gave an out rjT
of the usual examination for mental deficiency, but this
found unsatisfactory, as there was little space for recorc
details and it interfered with the officer’s individuality =
making examinations. The cards for each case are fin
bound together and at the termination of the case go into
files. More elaborate records for the insane or suspected
sane are, of course, kept, as is done in the usual psychopa T
ward, on regular history forms. Outside of the hospitals, li
ever, the records at Ellis Island must necessarily be reducet
simple terms, and only the most essential things are redi
to writing.

Finally, with regard to method of certification, the usual f
which is in common use at all stations is the one employed, I
of course the diagnosis used in certification corresponds to
terms used in the law, namely, insanity, feeble-mindedness,
becility, idiocy, and epilepsy. In the certification of me
cases it is usually required that three officers concur in
certificate and sign it, if they are available, but two are s
cient to meet the requirements of the law and regulation,'
this port.

r i

MENTAL EXAMINATION OF ALIENS. Ill

f. Form 169.

HOLD FOR FURTHER MEDICAL EXAMINATION.1

U. S. DEPARTMENT OF LABOR.

IMMIGRATION SERVICE.

me Age Nat. Race

dved S. S. No. Reg. by

Inspector.

ise of detention :

1 Reverse side has blank lines for further remarks.

LITERATURE.

The following brief list of literature is recommended to
inexperienced officer. Further reading will very naturally i
gest itself as he gains in experience. A more detailed lis
therefore considered unnecessary.

Outline of Psychiatry, by William A. White. The Journa
Nervous and Mental Disease Publishing Co., New York
Lectures on Clinical Psychiatry, by Emil Krapelin ; revised
edited by Thomas Johnstone. Wm. Wood & Co., New Y
Mental Deficiency, by A. F. Tredgold. Bailliere, Tindall & (
London ; and Wm. Wood & Co., New York.

Health and Medical Inspection of School Children — article
Mental Deficiency, by Walter S. Cornell. F. A. Davis 1
lishing Co., Philadelphia.

The Individual Delinquent, by William Healy. Little, Brov
Co,. Boston.

A Method of Measuring the Development of the Intelligenc
Young Children, Alfred Binet and Th. Simon. Transli
by Clara Harrison Town. Chicago Medical Book Co.,
cag .

The Psychology of Insanity, by Bernard Hart. Cambr
Manuals, G. P. Putnam’s Sons, New York.

(112)

t '• -

. r-

t±

Ill

. . 1 q

O'1

INDEX.

Page.

if phrases used in mental tests 24, 70, 71

a ed knowledge of alien, ascertaining

ihion :

C alien under bond

C wife or minor children of naturalized subject.

hi ism, chronic

an, effect on mental development of children..

e s

□ ant for deported alien

t Union tests

•c of special inquiry :

Ecisions of, final

Ecisions of, based on medical certificates,
•cof medical officers.

released aliens

Cisses which may be released under.

58
9

39, 70

) istories .
test

■bil syphilis
if ate :

ifation .

Qestions x • aid in.

Rzarding care of deported alien.
r9889° — 18 — —8

72, 105
33
48

113

114

INDEX.

Childhood and infancy, diagnosis in

Children of resident alien

Chorea

Chronic alcoholism

Civil surgeons, employement of

Competent medical examination

Conference, international, on immigration

Constitutional psychopathic inferiority

Construction tests

Contagious diseases, classification and description of

Copying test

Counting and mathematical tests

Cretinism, examination of children for

Cross and circle frame test

Cube test

Dangerous contagious diseases

Degeneracy, importance of physical signs of
Dementia :

Prsecox

Paralytic

Senile

Deportation of aliens

Detention of aliens for medical examination

Diagnosis, promptness required

In infancy and early childhood

Diamond frame tests

Ellis Island :

Procedure at

History of cases certified as mentally defective

History of cases certified as insane

Blank forms used at

Employment of alien mental defect’ves on vessels...

Entrance of alien in violation of law

Epilepsy

itri
| lit;
I IK
(r

4 r

INDEX.

115

jimination: rage

Primary inspection I 12

Secondary examination 19

Physical 20

Mental 21

Taking history of = 19

Intensive examination, proper environment and atti-
tude for 15

Physical and mental examination to be conducted by

United States Public Health Service 47, 54, 60

Questions for use in mental examination 61

I Reexamination 39

ludable classes 51

When they may be landed 56

ert medical witnesses 54

ile-mindedness, definition (footnote) 8

iald — Healy-Fernald construction test 33

s, comment on imposition of 10

aal tests of mentality 19

Sition, history of conditions during 49

y-Fernald construction test 33

y frame 32

dity, factor in psychoses 49

tries of cases 72. 105

ital management of mental cases 46

ocephalus, examination of children for 21,37

■su'ia 49

rates 26. 27. 28, 30, 36

igrant form board 32

gration officers in foreign service 59

gration law 51

116

INDEX.

Infancy anrl early childhood, diagnosis in

Infectious diseases, effect on mental growth of children f

Insanity :li

Inspectors on immigrant vessels “

Intensive examinations, proper environment and attitude ;i

for i

International conference for regulating immigration, etc_ *

Interpreters, use of

Introduction

Investigation of public-charge mental cases n

L. E

Laws bearing on mental inspection of aliens:

Summary

Law of 1917 : ,

Literacy test

1 jS

Loathsome contagious diseases, classification of ■

hat

Maintenance of aliens during detention 46, E

Malnutrition, effect on mental growth of children

Mathematical tests

Matrons on immigrant vessels

Medical examiners, qualifications of

Mental activities, testing of ]

Mental examination of suspected defectives •

Questions useful in 14, (

Muscular incoordination, examination of children for :

I et:

ta!

lie’

Dll

N. in

Neurasthenia !(

Normal immigrant, knowledge of I*"

Paralysis, examination of children for ^

Performance tests

Physical examination of suspected mental defectives 1111

Primary inspection *

Problems used for mental tests 24, ®

Psychiatry, application to mental tests ;•

INDEX.

117

III

Bj'hopathic inferiority, constitutional

uic-eharge mental cases

u ic Healtii Service officers to examine aliens

tl’iose of manual

eidties :

For bringing in diseased aliens

For employing diseased seamen on immigrant vessels-

Page.

44
46. 56
54

jjrantinable diseases 58

actions for use in mental examinations 14, 61

3 Equivalents in foreign languages 69

To ascertain reasoning ability 24

laminations 39

4ise of alien from custody 57

loval of alien from vessel for inspection 53

gating digits 28

Nets, effect on mental development of children 37

ation of immigrant vessels

len :

Ixamination and certification of

penalties for employing diseased aliens on passenger

vessels

idary amentia

idary examinations

Bin form board

g|; of degeneracy

nan — Binet-Simon tests

rile sums

einboat picture form

unary of laws bearing on mental inspections

,s?cted mental defectives, secondary examination of

-■

iBlis, cerebral

$na of degeneracy

60
21
19
31
13, 20
39, 70
27
34
8.
19
48
13, 20

118

INDEX,

Tests, specific :

Binet-Simon

Casuist

Construction, Healy-Fernald

Copying

Counting and mathematics

Cross and circle frame

Cube

Diamond frame

Healy frame

Immigrant form board

Literacy

Mathematical

Performance

Problems 24, '

Repeating digits

Sequin form board

Simple sums_

Steamboat picture form

Transportation regulations

Tuberculosis l

Vocabularies of foreign languages for use in question-
ing aliens

Warrant cases

Wife of resident alien

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